I believe that Dr Noah Greenspan of http://www.pulmarywellness.org says to do separately. BTW, he offers a six week course on pulmonary bootcamp. It is designed for anyone no matter what their condition. It is free. Look at the site. Let me know if you have any questions. He also offers free help for anyone. Is a Dr of Resp Therapy, EMT, paramedic, RT, etc. Amazing man. Amazing website.