I was doing clearance twice a day until about 2 months ago. There was a discussion about whether once daily was sufficient. I still work as an clinic rn daily, so didn't fit in 2x very much except when I would catch a cold (not covid) or feel sinuses acting up. I'm only going to an id doctor now through Ochsner. (my pulmonologist np left and I haven't got a new one yet). The vest was never offered. I feel so much better with the 7% saline nebs (only started 4 months ago-was on 3% before for a year), and this new routine (on for 2 months). I no longer cough up sputum during the rest of the day or night. It is a game changer so far.