@tconz I'm glad to see you are making progress in getting treated and in getting an appointment at NJH.
Levalbuterol or albuterol is inhaled or nebulized before the saline. It opens the airways so the saline penetrates better.
Most people use the Aerobika during or after nebulizing - some attach it to the nebulizer and do it at the same time. Each of us must find what works for their lungs.
Here is my routine:
2 puffs of my inhaler, after 5-10 minutes begin nebbing saline. When the urge to cough becomes overwhelming, put down the neb and do 5 breaths with the Aerobika, huff cough to bring up junk. Repeat neb-Aerobika-cough until the saline is gone or no more mucucs is coming out. This seems to work for me, has kept me off the big 3 for 3 years with only a few minor exacerbations. Before winter set in, with all its respiratory viruses & cold air, I was down to saline every other day but now I am faithful to stay healthy.
Sue