nebulizing albuterol and saline

Thank you so much for the advice. I will talk to my pulmo about it the next time I see him. Donna

Sodium Chloride designated DURABLE GOOD by MEDICARE?
Has anyone been able to figure out why Medicare doesn't pay for sodium chloride vials; they consider them a "durable good" such as a nebulizer. Or is there someone out there who has been able to get Medicare/Supplemental pay for sodium chloride (saline solution)? If so, please tell me your supplemental name and/or how you got this to be paid for. Thank you so very much!

Sodium Chloride designated DURABLE GOOD by MEDICARE?
Has anyone been able to figure out why Medicare doesn't pay for sodium chloride vials; they consider them a "durable good" such as a nebulizer. Or is there someone out there who has been able to get Medicare/Supplemental pay for sodium chloride (saline solution)? If so, please tell me your supplemental name and/or how you got this to be paid for. Thank you so very much!

Hi Donna,
Were you tested during your Pulmonary Function Tests to see if albuterol/levalbuterol is necessary? Whether it does in fact make a significant difference in opening your airways? I recently had PFTs and there was no significant improvement with albuterol so I do not use it.

Regarding the hypertonic saline, my doctor who is a BE/NTM expert, doesn't say 7% is better than 3% or for that matter .9% as there is little research to support this claim. There seems to be a feeling that hypertonic saline not only thins mucus but might be anti-microbial. Isotonic solution, like .9%, has the lowest amount of sodium chloride so perhaps it thins mucus, but is not anti-microbial.

I have all three and depending on if my voice is hoarse or if my throat is sore, I might step down from 7% to 3% or .9%. However, generally speaking, I tolerate the 7% well and might cough once or twice when I first start nebulizing but not throughout the session.

What's important is to find what is tolerable for you at this point in time and with your doctor's consent, go with that. From time to time, you can revisit your options.

Best,
Linda Esposito

My pulmonologist switched me to LEVALBUTEROL. I've had a much better experience. I may feel a little hyper, but it is not that crazy 1-2 hour heart racing, hands shaking experience.

I am new to all of this (MAC, Bronchiectasis, COPD and will begin treatment in a few weeks) and was wondering if the Levalbuterol is used in inhaler form after nebulizing sodium chloride 7%? I have been on Spiriva 2.5 and was told by others going through treatment I should get off Spiriva because of Bromides and switch to Levabuterol. It was also suggested I use Aerobika instead of my AirPhysio. Any feedback would help.

Hello, and welcome to Mayo Connect, where we are happy to walk this path with you.
First, I would like to point out that Connect is a community of people with similar conditions sharing their experiences and trying to help one another live well in spite of our health conditions. But each of us is unique, with different health and lung status and other conditions, so very much NOT "one size fits all."
Second, we are not medical professionals, and do NOT suggest you should substitute any of our suggestions for the directions given by your health care team.
Third, COPD is a fairly common disease, but bronchiectasis is uncommon (maybe 1-3 million people) , and MAC infection is rare (under 1/2 million people per year.) Many doctors have limited experience treating us, and may not be totally aware of the latest and best recommendations from the "gold standard" facilities like National Jewish Health, Mayo, Cleveland Clinic, and a few others. So you may read new things here that you would like to bring to your doctor's attention.

To answer your questions - Spiriva and its sister Symbicort are used by people here, depending on their other conditions.
Levalbuterol or Spiriva or Symbicort should be used before you neb with saline. It opens the airways and allows better penetration. I use Symbicort because I also have chronic asthma. My friend used Symbicort because he had COPD.
Most PEP devices, AirPhysio, Aerobika, Acapella - will help. The choice is individual - discuss with your doctor or ask for a visit with a respiratory therapist to see which is most helpful to you. I prefre the Aerobika, but keep a Acapella in my car in case I need help bringing up mucus when out and about.
Other here can chime in with their preferences.
Are you comfortable calling your doc with questions?
Sue