Do we need airway clearance if no symptoms?

@tglatthorn Do you need airway clearance? Yes - you answered your own question - when you cough you bring up yellow/green sputum with white clumps - that is where the germs hide and multiply.

Maybe you need some coaching in how to effectively do airway clearance, because properly done it should not make your ribs hurt.
Here is a good video about how and why -

As for cleaning and sterilizing your nebulizer - forget the hoses, you only need to do the nebulizer cup and mouthpiece. Here is one video explaining how:
https://sterilizerguide.com/how-to-sterilize-nebulizer-parts/2
(Note - if you have M abscessus, the vinegar soak is not enough. Boil or steam.)

Did you have any instruction from your doctor's team about how to do airway clearance?

I use my nebulizer twice a day with acetylsisteine and budesinide. I make sure I wash my hands before setting up to use it. After using it, the only parts I clean are the cup and mouthpiece. I'm not breathing into the tube so I don't clean or sterilize that. I just let the nebulizer run for a few minutes after removing the cup, so that any moisture in the tube is dried up. Then, I hang it till the next time I need it. I also use the disposable neb kit, so I replace it once a month, Medicare will cover two kits a month. I soak the cup and the mouthpiece in a solution of half and half of water and white vinegar after rinsing for an hour once a week. Rinse with clear water after, shake as much water out of it as I can, then let it air dry in a container I reserve just for my neb kit. I've been using a nebulizer for 16 years. If you're coughing bad enough to hurt your ribs, you definitely need to nebulize..

@vstankie
is that mucomist you are using? How do you find the taste? I have read that it is very off putting.

Have you tried using albuterol 10-15 mins before the saline ? I use 7% saline , and at first I was having your same reaction to nebulizing - intense coughing . In some people , the saline can cause bronchospasm . My doctor had me start using the albuterol first , and I’ve not had the severe coughing anymore . It also helps me to get the deeper mucus out. Maybe worth a try?

I am new to nebulizing. Most participants seem to be boiling their neb cups and mouth pieces. The instructions on my set are to wash in soapy water, rinse and airdry. I am worried about my tap water but more afraid of heating the plastic to sterilize. I am very frightened about breathing
microplastic particulates from heat- degraded plastic. So, I am washing the pieces in warm soapy water and rinsing and soaking in sterile water at room temp, then replacing equipment monthly. Thanks for the tip about letting the compresser dry the tubing. I wipe the tip with alcohol before reatatching it to the med cup.

@suzieq11 There are two types of nebulizer cups, disposable - meant for a single use by one person, and reusable - meant to be used for three to six months.

The disposable ones (generally) will not withstand boiling or other sterilizing techniques. But biofilm can attach over time, harboring mycobacteria, so frequent replacement is necessary. In my opinion, after a lot of reading, that would be every week or two if you are at risk of infection, and every week if you have MAC. When my Mom, who had bronchiectasis, asthma and congestive heart failure, was hospitalized for many weeks, the disposable nebs were replaced every 3 days by the respiratory therapist.

Reusable cups are made to withstand sterilization by boiling, microwave steamer or a baby bottle sterilizer. But your concern about the plastic degrading is real, that is why frequent replacement is recommended. The interval varies by manufacturer from 3-6 months. When I used mine daily, I replaced every 3 months (I now use a different type, which is replaced when the flow weakens.)

Did you get any guidance from your pulmonologist about how often to replace the nebulizer cups?

No, I have been getting my info from this group. The resp therapist told me to replace the first one in 6 months, but after 6 weeks it looked like it was degrading. I ordered a replacement and those instruction said once month. I use it twice per day. I have active MAC.

@irenea8 it smells bad, but I've gotten used to it. And it did help to thin the mucus, but when had been on brinsupri for 4 months, the amount of mucus I was able to bring up, kept listening and listening. Now I am not bringing up any mucus, but my pulmonologist said, do not stop the airway clearance, keep trying, so she's going to add 7%. Sodium chloride to my nebulizing meds in hopes to thin the mucus, more.

@vstankie i really need to remember to look at what is being typed when I dictate. My mucus output kept lessening not listening

@sueinmn
I was in dishwasher and the sterilize in baby bottle sterilizer.