I also do the same as you my routine goes like this nebulize with albuterol, followed by 7% saline, then flutter valve 20-30 times. The first time is between 7-8 am daily. Around 1-2pm I usually take 2-3 puffs of my rescue inhaler inhaler of albuterol if needed, which I usually do. Then around 6:00pm another nebulizer treatment the same as a.m. following that I take Annoro Elipta not Breo, to help me through the night while I sleep.