White foamy mucus makes me think of reflux/GERD. How are you doing off of the PPI? Many lung disease suffers have reflux/GERD. I understand the rationale of getting off these meds but often people with lung disease require them to keep irritating acid from getting into the lungs. Also, nebulizing albuterol tends to relax the lower esophageal sphincter. Using an albuterol inhaler 15 mins prior to saline has less impact on the sphincter.

Lung Matters Protocol are guidelines to follow with caution and consultation from your doctor. It's grown from the documentation of one woman's journey. Yet, one size does not fit all. Several of the links used as supported evidence are not relevant, some are dated. It seems there's no room for any debate. One very positive piece of advice there, however, is the importance of airway clearance. In this way, the site has done a huge service to bronchiectasis sufferers as airway clearance is the cornerstone of treatment.