I use a nebulizer with Brovana twice daily but follow it up with a puff of Alvesco 160mcg. I noticed that you stated that if one is nebulizing saline it is helpful to use a puff of albuterol or levalbuterol prior to nebulizing. I only need the levalbuterol rescue inhaler perhaps one or two times per year, and use it at the docs office when doing the PFT. Have been on this protocol for almost 7 years and have an Allergy/Asthma Specialist for a pulmonary doc.