My pulmonologist was insistent that I use albuterol before the saline, even though it was making me jittery, making my heart race, and sometimes kept me awake at night even though I didn’t use it before bedtime. I finally stopped using it in the evening and did the albuterol only in the morning but still doing saline twice a day. She finally prescribed levalbuteral which was a little better but I still ended up using it morning only. When I went to NJH and they did my lung functioning test, part of it included checking the effectiveness of albuterol with me and it made minimal difference so I don’t use it at all now. Saline only.