What can be done if despite a theoretically correct asthma treatment there are still many symptoms? This is common, as current asthma inhalers are usually given based on international guidelines (such as GINA Asthma - https://ginasthma.org/). Therefore, even non-specialist doctors are usually able to prescribe the right inhalers. 

If there are still symptoms present or many asthma attacks, several issues may be happening: 

- inhaler technique may not be optimal 

- the prescribed doses of medication may not be enough 

- there may still be environmental triggers for the asthma at home or at work 

- repeated viral infections may be worsening the airway inflammation and leading to a loss of asthma control.

Remember you can watch these episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Find more information on the website: https://www.toplunghealth.com/

Twitter: Stefan Cristian Stanel (@scstanel) / Twitter

This is a discussion and guide for those who may be suffering from COPD or know someone who is. Chronic obstructive pulmonary disease is a condition affecting the airways and the lungs, marked by shortness of breath on exertion and chronic productive cough. These symptoms tend to get worse over time and this leads to much suffering. COPD is a combination of chronic bronchitis and emphysema. 

World COPD day is marked in 2022 on 16 November. It is a moment to raise awareness of this condition, to get more people to check their lungs and diagnose it early. It is a preventable condition for the most part, especially if we all avoided smoking and environmental air pollutants, both indoor and outdoor. #worldcopdday 

This is an unedited episode (as most of my content is) because I am trying to explain these concepts in a friendly, human way, while still following a structure that I hope is easy for you to follow. I am always looking for ways to improve my content, so if you have any suggestions, please connect with me and let me know.

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

In this episode I discuss about using corticosteroids (such as prednisone / prednisolone etc.) for asthma exacerbations (flare-ups). Based on a question I received on the YouTube channel I talk about reasons for using steroids and if this treatment would result in complete improvement of symptoms during a worsening of asthma control. I also explain why the effect of these corticosteroid burst lasts for a while longer than the actual prescribed treatment duration. 

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

When are inhaled corticosteroids (ICS) used in the treatment of COPD (chronic obstructive pulmonary disease)? Inhaled corticosteroids are normally a treatment for asthma, however they are useful for people who have many COPD flare-ups (exacerbations) and more severe COPD.  The question in the video specifically talks about using Flovent (fluticasone) in addition to Anoro Ellipta (a combination of two bronchodilators).

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

Ep. 7 - Using saline nebulizers and other forms of salinity to treat respiratory conditions. I discuss normal saline (0.9%), hypertonic saline, going into salt mines and if salt pipes serve any purpose. Some salt-based inhaled therapies have proven efficacy (saline nebulizers). Salt pipes don't seem to be worth it in my opinion. Also I would be wary of dubious health claims regarding unusual benefits of "Himalayan salt". 

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

What is the best time to take your inhaler? Morning, afternoon, evening? Does it matter? Some inhalers only require once daily use, while others can be twice daily. Some inhalers have a faster onset of action compared to others. All these details are important and doctors will usually take them into account when giving you your prescription.

As most people are normally most active during the day, the morning is likely to be the best time to use inhalers which are only taken once daily, although there is no strict rule around this. This is because the peak concentration of the active substance in the airways will be in the hours after inhalation and this concentration will then slowly decline throughout the day.

If your inhaler is taken twice daily (i.e. one puff in the morning, one in the evening), this suggests that the maximum effect of the inhaler will last for around 12 hours. There is no sharp cut-off however and in some instances a twice daily inhaler may only be prescribed once daily (if your doctor believes this would be enough in your case).

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

Do inhalers help in the recovery period after chest infections? This is a common question, as many people struggle with some lingering symptoms in the weeks after a respiratory infection (viral or bacterial). There may be a residual cough which may last for up to 6-8 weeks and in some cases there may be some wheeze.  If your doctors suspects that there is some ongoing airway inflammation or hyperresponsiveness, they may prescribe an inhaler for a few months to help your recovery. This is not useful for most patients, but for some it can help. It is important however to only use inhalers in this situation if it is indeed your doctor's recommendation. Please see your doctor for personalized health advice.

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

Restriction means the lungs cannot expand fully, therefore they cannot be fully inflated with air. 

In this episode I discuss many potential causes for restrictive lung disease, answering a question received on the channel. A restrictive pattern can be found on routine spirometry or sometimes more complex lung function tests are performed revealing lower than expected lung volumes (restriction). 

This can be due to issues outside of the lungs (chest deformity), pleural thickening restricting lung movement etc. Sometimes there may be a neuro-muscular disease which causes restriction. Within the lungs, there may be pulmonary fibrosis (scarring of the lungs), which again has very many causes. Sometimes restriction can be due to long term complications of infections such as tuberculosis. 

Treatment for lung restriction aims at treating the cause as much as possible. Sometimes there are not many effective therapies. Maintaining respiratory muscle strength is essential. 

Find more information on the website: https://www.toplunghealth.com/

Watch episodes as videos on my YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

A question I received on my YouTube channels about whether someone could have a mild form of asthma without knowing or having a formal diagnosis. This is a common situation actually, especially if asthma appears a bit later in life (which is entirely possible). Symptoms of asthma can include: wheezing, chest tightness (constriction), coughing. These symptoms usually come and go, with good days and bad days (variable chest symptoms). Mild asthma attacks can be triggered by inhaling dust or pollens you may be allergic to. I would highly recommend that if you are having respiratory symptoms or breathing difficulties, to seek some advice from your doctor, to see what is going on. 

The website: https://www.toplunghealth.com/

My YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter

In this episode I try to raise awareness of occupational lung diseases. These are very preventable if respiratory protection is used (i.e. particulate filter masks). Many people work in dusty or otherwise unhealthy environments. It is important to try to work in well ventilated areas, to use respiratory protection, seek advice from your employer and doctors if you are developing respiratory problems at work. Very important to think long term! What will your breathing be like in 10-20 years? 

The website: https://www.toplunghealth.com/

My YouTube channel: https://www.youtube.com/c/DrStefanCristianStanel

Stefan Cristian Stanel (@scstanel) / Twitter