@doberdoo I may be the odd man out here, but I use my Breyna inhaler instead of a levalbuterol neb. My pulmonologist, who specializes in treating complex asthma or asthma with Bronchiectasis or COPD, has "weaned" me off levalbuterol nebs except during a serious exacerbation. So now, I use Breyna, rinse my mouth, wait 15 minutes then nebulize saline, followed by airway clearance.
The purpose of Breyna (or Symbicort or formoterol/budesonide combo - all the same drug) it to keep the airways open and reduce inflammation long term, as opposed to the short-term effect of albuterol/levalbuterol.

Maybe you can ask your pulmonologist if this routine might work for you?