Albuterol to open airways

Posted by bsardella @bsardella, Nov 20 5:10pm

I am not producing very much mucus when using my Aerobika so my doctor prescribed albuterol to open the airways. I watched a presentation by Dr. McShane a few months ago and I think she recommended using a saline solution rather than albuterol. My doctor doesn’t recommend saline. It’s all very confusing! Does anyone have any thoughts about this?

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@laborday24

Njh respiratory therapist albuteral 10 minutes to open up airway then saline 10 minutes I am here now

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I do something very similar to that. Albuterol 10-15 mins then wait 10-15 mins to give the albuterol a chance to open airways, then usually 7% saline for 15-20 mins and Areobika intermittently while doing the saline. Now I realize it takes time for all this but I do bring up a lot of mucus!!!! Especially in the morning as it has settled I believe in my lower lobes in the night while sleeping. I then am usually good for 6-7 hrs. Now Mayo classified my BE as significant. So I also repeat at bedtime

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It’ll be available in December!

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Hey guys has anyone been on clofazimine

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@laborday24

Hey guys has anyone been on clofazimine

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I just completed 14 months of Clofazimine along with Azith and Ethambutol. It took care of the Mac and I had a nice tan even in Winter. I can no longer take Rifampin as it caused acute kidney failure and I lost 50% of my kidney function. But the clofazimine did its job quickly and I have been MAC free for over a year now. I did have a little trouble with upset bowels but not nearly as much as the side effects from Rifampin. Was it worth it? Absolutely.

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@greeneyes8

I just completed 14 months of Clofazimine along with Azith and Ethambutol. It took care of the Mac and I had a nice tan even in Winter. I can no longer take Rifampin as it caused acute kidney failure and I lost 50% of my kidney function. But the clofazimine did its job quickly and I have been MAC free for over a year now. I did have a little trouble with upset bowels but not nearly as much as the side effects from Rifampin. Was it worth it? Absolutely.

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Thank you for getting back to me. That is one of meds. I had no issues on the big three but resistant to azithromycin. I am al going on ethamutol refambutal and one that begins with an L. Did you have cavity mac

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I had MAC intracellulare along with BX, which is still in the mild range. I do airway clearance every day and i am now able to get mucus up, had a hard time in the beginning. I am treated at NJH and am lucky to have Dr. Daley taking care of me. I continue to send in monthly sputum samples and keeping my fingers crossed they continue to be negative. I wish you the best of luck and hope the meds do the trick.

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@becleartoday

If your doctor doesn’t recommend saline, he or she is not a bronchiectasis expert. To advocate for yourself, you might want to request a three month trial with .9 isotonic saline. Isotonic saline is the same salt level as our bodily fluids -tears, blood -so it would be a conservative approach and I find it difficult to believe that a pulmonologist would push back on it.

I’ve heard that there is an overuse of albuterol in our community. Just because one person is using it doesn’t mean everyone else should. A very experienced respiratory therapist told me that people usually know when they need it. They have tightness in their chest. However, the gold standard is when you have your Pulmonary Function Tests, first have them without albuterol and then with albuterol. If there is a substantial improvement with the albuterol then perhaps it’s worth using.

There are side effects with albuterol and levalbuterol, including jitteriness and the possibility of reflux from relaxing the LES, the lower esophageal sphincter.

In the meantime, depending on what’s available in your community, you might want to try to find someone who understands BE well and regularly attends PE and NTM conferences.

The good news is that over the next three years the COPD foundation along with NTM Info & Research will be certifying centers throughout the US. In this first round of certifications, 33 centers were approved. The goal is to reach 150. So, if there isn’t an expert available in your community now, there might be in the near future. However, in the meantime, you might think about going to one of the centers.

Remember… Never change your current care without first discussing it with your medical team.

I hope this is helpful,
Linda Esposito

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I had a “substantial” ie I met the threshold of 10% improvement with Albuterol on PFT, but just barely. When I asked my doctor for a prescription for 7 % saline, he included albuterol without any explanation as to why. When I asked if I could do saline only, he said “sure” again without explaining what the benefit of the albuterol, if any might be. So, I only did the saline when I started AC, but then my pulmonary rehab therapists thought albuterol is important to open airways so suggested I include before AC. For the last couple weeks I have done albuterol before saline and I notice no difference than nebulizing saline only. I have no shortness of breath or chest tightness. Perhaps I should just stick with the saline, as was my initial inclination.

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I believed Dr McShane said that if you do Albuterol as part of AC, do it before and separately from saline, ie don’t mix the Albuterol in with saline, so as not to dilute the 7% saline. I may be wrong but I don’t recall her recommending against albuterol for those using it as part of AC.

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@bayarea58

I had a “substantial” ie I met the threshold of 10% improvement with Albuterol on PFT, but just barely. When I asked my doctor for a prescription for 7 % saline, he included albuterol without any explanation as to why. When I asked if I could do saline only, he said “sure” again without explaining what the benefit of the albuterol, if any might be. So, I only did the saline when I started AC, but then my pulmonary rehab therapists thought albuterol is important to open airways so suggested I include before AC. For the last couple weeks I have done albuterol before saline and I notice no difference than nebulizing saline only. I have no shortness of breath or chest tightness. Perhaps I should just stick with the saline, as was my initial inclination.

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I would run it by your doctor. It sounds like he would agree with you!

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@bayarea58

I believed Dr McShane said that if you do Albuterol as part of AC, do it before and separately from saline, ie don’t mix the Albuterol in with saline, so as not to dilute the 7% saline. I may be wrong but I don’t recall her recommending against albuterol for those using it as part of AC.

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Yes, in a recent webinar, she said to use the Albuterol (or Levalbuterol) to open the airways first, then do the nebulizing of saline. She also said it's more effective to do nebulizing first and then vest and Aerobika afterward, much to the dismay of a lot of people in my support group because of time constraints. It makes sense with a traditional vest particularly because it is squeezing the airways and working against getting the saline into them to wet them down to allow you to clear the mucus.

But something she said in that same webinar is one of the reasons I've continued with Albuterol, even though my PEF didn't change with it when tested at NJH. She said that NTMs like to hang out in the very small airways at the ends. Yikes. I was first prescribed Albuterol when I got my Monarch vest about three years ago and have used it since. Of course when I was on Arikayce, it was recommended to continue it to avoid bronchospasms. My pulmonologist and I discussed my continuing or stopping it when I saw him last week, and since I tolerate the Albuterol well, I will continue to use it for now. Been off all meds since June and so far so good!

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