Albuterol to open airways

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!

I am one of the patients that developed breathing symptoms when I was doing Sprint Triathlons (swim portion). I went to PCP. PCP ordered CT and saw some areas of concern and referred me to Pulmonology.

Pulmonology had me do a very extensive pulmonology exam. Nothing came back. Saw first pulmonologist and quite frankly not much advise. So went back to PCP and said try Atrovent. Atrovent actually made is worse. So my other doctors said try albuterol. This seem to help some but did not stop it.

Then PCP said try Advair. This seemed to really help but was an ongoing every day treatment that I was concerned with as contains a steroid powder.

So back to another appt. with pulmonolgist (different one). This pumonolgist said my lungs and physical condition were good. However was quite frankly the test they do cannot specifically always determine if you have asthma or other disease as you cannot duplicate the same triggers. I was given 3 different mists to breathe in that represent the normal triggers but does not duplicate what your actually triggers are.

This pulmonolgist said use albuterol prior to race and not the daily advair. So you can see I have been all over the treatment scene. I have not had a sprint triathlon yet to see if the albuterol will work. Personally, and it just my opinion not a medical diagnosis, is that I have a psychological response to the swimming portion as you are over your head in water and I freeze up. The reason I say this is that I can swim a mile in a lap pool without incident.

In the past I had no issues at sprint triathons during the swim. I got injured sliding off a dock into water tearing up the back of my legs and was the first time I had the breathing problem and could not finish swim. So I think that epiosode started the trigger and the swim triggered that reaction again

Thus you can see why the pulmonary test I was given could not duplicate the trigger. I think important for all with breathing problems to try and see what triggers them and the try to address them with the medical help of your medical providers.

Yes, I remembered her comment about NTM hanging out at the periphery, so when my pulmonary therapists explained what Albuterol does, opens the airways so medications (saline) can get in deeper, I thought “oh, ok, I think I want that”. Still, I haven’t noticed any difference in AC with or without. I do follow her suggested protocol of doing saline before and separate from vest, Aerobika, active breathing. One thing that Dr McShane suggested that I haven’t tried yet but is next on the list is to try doing two vials of saline, to really wet things down I believe is how she put it, before moving on to the vest/Aerobika/active breathing, etc. That of course increases the time needed which as you point out is already increased by doing the saline separately. I am still somewhat of a newbie to everything and working to get more efficient at all the things, but I have very little mucus, if any, so trying the extra saline seems worthwhile to me. Congratulations on finishing your antibiotic protocol, wishing you all the best!

I used to do triathlons and agree that open water swimming is far more psychologically stressful than the pool, add a negative association to that, like an injury and it makes perfect sense to me that the stress of open water swimming could trigger physical symptoms, such as shortness of breath in your case. In addition to inhalers, are you working on your mind? There are a lot of resources these days on sports psychology, mindfulness, etc. It may be helpful to add a daily practice, if you aren’t already, that you can call upon when you hit the open water.

Yes, I remembered her comment about NTM hanging out at the periphery, so when my pulmonary therapists explained what Albuterol does, opens the airways so medications (saline) can get in deeper, I thought “oh, ok, I think I want that”. Still, I haven’t noticed any difference in AC with or without. I do follow her suggested protocol of doing saline before and separate from vest, Aerobika, active breathing. One thing that Dr McShane suggested that I haven’t tried yet but is next on the list is to try doing two vials of saline, to really wet things down I believe is how she put it, before moving on to the vest/Aerobika/active breathing, etc. That of course increases the time needed which as you point out is already increased by doing the saline separately. I am still somewhat of a newbie to everything and working to get more efficient at all the things, but I have very little mucus, if any, so trying the extra saline seems worthwhile to me. Congratulations on finishing your antibiotic protocol, wishing you all the best!

IMHO, you are doing the right thing -- experimenting with what works best for you. I often say our journey with NTM/BE is as individual as our fingerprints, and so what works great for one person may not work at all for another.

My vest is a Monarch, so it uses magnets, not compression. After Dr. McShane's presentation, I split nebulizing apart from Aerobika and vest for a couple weeks. Then I did every other day in tandem or separately to compare and honestly didn't seem to have any difference in production. I do them separately whenever I feel I need to be a little more thorough, though, just out of an abundance of caution.

In my group, some people have more success with the Pari Trek and the cups that come with it over the Aeroclipse and Ombra. Some folks don't really clear until sometime after nebulizing and then by using postural drainage or cardio workouts. Keep experimenting and you'll find your solutions!

AFA albuterol, I don't necessarily notice any greater production either. But I keep it up, mainly because of that comment. I guess if my smaller airways are not compromised, they wouldn't necessarily produce more mucus, but I do want to keep them as bacteria free as possible!

Thanks! Hoping that my "drug vacation" is a very long one. 🙂

Laurel

How does a vest that uses magnets work? Is it safer for rib bruising or pain etc?

IMHO, you are doing the right thing -- experimenting with what works best for you. I often say our journey with NTM/BE is as individual as our fingerprints, and so what works great for one person may not work at all for another.

My vest is a Monarch, so it uses magnets, not compression. After Dr. McShane's presentation, I split nebulizing apart from Aerobika and vest for a couple weeks. Then I did every other day in tandem or separately to compare and honestly didn't seem to have any difference in production. I do them separately whenever I feel I need to be a little more thorough, though, just out of an abundance of caution.

In my group, some people have more success with the Pari Trek and the cups that come with it over the Aeroclipse and Ombra. Some folks don't really clear until sometime after nebulizing and then by using postural drainage or cardio workouts. Keep experimenting and you'll find your solutions!

AFA albuterol, I don't necessarily notice any greater production either. But I keep it up, mainly because of that comment. I guess if my smaller airways are not compromised, they wouldn't necessarily produce more mucus, but I do want to keep them as bacteria free as possible!

Thanks! Hoping that my "drug vacation" is a very long one. 🙂

Laurel

@bayarea58
Thanks for the feedback and your information is what MCC is all about! I do think I need to address this mentally not just physically. Everyone (doctors) wants to address it with medications, inhalers and tests.

I have been trying to say to my PCP and pulmonoligists that I think I am having a psychological response to the open water swim injury and then the breathing issue. The sprint triathlon swim is 1/4 mile. When I train I do a mile. One lap pool I use at middle goes to 6 foot 8 inches so is over my head. I have no problems swimming the mile but like you say swimming in a pool (espceially not having to sight) is nothing like swimming in open water.

Back in March I slid of a dock to enter water and tore up the back of both legs. I was wearing a wet suit so the injury started just below my thighs. I tore up both legs on barnacles on side of dock that no one knew about. Antibiotics and 3 weeks of recovery. Now have tremendous scars on both legs.

At the race I tried to swim even knowing I had injured my legs. However my legs hurt and then suddenly got shortness of breath (felt like I could not get enough air in) and had to be brought back to dock. As I was being pulled back I could see a lot of blood in water. How stupid I felt by trying to finish swim knowing I was injured. One fellow swimmer said "you are attracted all the sharks."

I agree with you on the psychological part of this. I do see a medication specialist for my PTSD/anxiety/panic disorder that I take medication for and has been in remittance for several years.

Can I ask you to provide some information on the sports psychology and mindfulness sites that you mentioned.

It took a long time to recover from injury. Then just when ready to try again came down with COVID (first time and took all shots and boosters) in June and out again for 3 moths. I was scheduled to do 2 Sprint Triathlons in November. One got cancelled due to permits and the other due to debris in water from hurricanes. So NO sprint triathlons in year 2024 since my attempt and injury back in March.