Toni - Every time I think "I don't need to neb" reality smacks me on the head with increased fatigue, coughing or other symptoms. I find that nebbing does a far better job of loosening secretions than the inhaler, and I bring up more "junk." This is obvious when I skip nebbing for a few days (still doing inhalers and airway clearance) and I cough up thick clots after each of the first few nebs, then the secretions thin again.
Sue