Timing of nebulizing - before or after meals
Hi all,
My husband, who has Bronchiectasis, is currently testing negative for MAC following 11 months of killer antibiotics, which have been suspended after they came way too close to ending him over this past summer.
He nebulizes with albuterol followed by 7% saline twice a day. Some of the comments within discussions that I have seen in this group suggest that there be a 2-3 hour time lag before or after a meal, before nebulizing. The same was suggested on timing of sputum collection for culture purposes.
His ID/Pulmonology team at Johns Hopkins have never provided any advice on the subject. Since we have gotten most of our knowledge and survival tips from this group, what are the best practice options you have found to be most workable? Any thoughts or input are welcome.
You have been an invaluable source of information, guidance and support which has been very much appreciated.
Thank you.
Melissa
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Melissa,
I get up at 7 a.m. have breakfast, go to the gym, etc. Then I neb at 9 a.m.
After dinner at 5-5:30 p.m., I neb at 7 or 7:30 p.m.
I'll ask my pulmonologist.
Harry
Reading these responses just reinforces to me that we are all different, with differing health issues in addition to bronchiectasis, differing levels of severity, different meds (inhaler vs albuterol neb) and different schedules and lifestyles.
We each need to find a routine that works for us and can fit into our daily schedule well enough that we can make it routine.
For example, unless I walk or stretch before I do ACT, I don't produce sputum (I am in maintenance, no active infection.) My pulmonologist says this is typical - whether you realize it or not the ACT is breaking up the mucus & moving it from small airways to larger ones. My life schedule is wildly variable, and unless I am having an exacerbation or we are under air quality alerts, I only neb saline once a day, 4-5 times a week. But I faithfully use my inhaler (Symbicort) on rising and at bedtime. I use my Aerobika and active breathing as I read my paper. And I do active breathing with huff coughing during and after exercise (@scoop) - people look at me funny when I step of the walking trail to do it but meh...
GERD doesn't seem to bother me, so I don't worry about timing with food or drink, though being well-hydrated helps bring up more mucus.
So, I guess the best takeaway from this discussion is that you need to make ACT work for you and your life.
Sue
Hi Melissa,
Thank you for your post. It helps to know what others are doing.
My pulmonologist offers no guidance about nebulizing or airway clearance techniques. Thank goodness for this group as it is one my main sources of information.
My routine is as follows: My dog wakes me every morning between 6 and 6:30 a.m. After walking and feeding him, I take vitamins, probiotics and medication with some water and then nebulize with 7% saline which helps me expel a good amount of gunk. This is followed by huff coughing and 20 minutes of compression vest. After that, I will have a hot drink, and maybe a small snack. I have lunch at around 12noon. At 3:30 I do the same routine - walk dog, neb, huff cough, vest. As for me, I prefer having an empty stomach while nebulizing. It just works better for me. Before bed I will do some airway clearance then off to dreamland. Best wishes to you and your husband.
When I Nebulize at 11:00 AM - stuff doesn't come up and out till around 3:00 PM - I have a big lag time. Thus it's hard to do evenings as I would be coughing stuff up while I try to sleep. I guess everyone is different in that respect.
I have found that, if I don’t hydrate before Acts that my throat and sometimes my chest get irritated and feel like they are burning. I also do not produce any sputum.
I have the same probably with doing airway clearance before breakfast. I have acid reflux and have to eat dinner early. About 7 or 8 pm.is when I have most mucus. So I try to be finished with dinner by 5 pm.. Start airway clearance around 7 pm. snd it last for hours. Can not eat or drink afterwards because of acid reflux. I am very dehydrated until about midday. After 3 years of nebulizing and smart vest I still do not have a schedule for airway clearance. I would love to have a decent routine so that I can get to bed earlier
I need to clarify my comment about doing airway clearance on “empty stomach.” The info I was referring to is on postural drainage which it sounds like most of you don’t do. I looked at my Mayo pt. ed material “Tecniques for Clearing Lungs” (postural drainage) and it says do it before or two hours after meals. It does not say no water or clear liquids. Those pass thru stomach pretty quickly and I usu sip as I neb and use Aerobika.
I checked my brochure from them on nebs and it has no instruction about timing with meals.
Please talk to your doc about seeing a respiratory therapist - with your vest - to get a better airway clearance routine established. Besides being so disruptive to your life, spending that much time at it has to be irritating to your lungs and ribs, which could be making things worse.
Sue
Your yoga and postural drainage mention inspired me to look up the link between them. I found this article. Granted, most of the poses are challenging and geared for younger folks but they may be modified and can be helpful for the opening the lungs. https://www.wellcurve.in/blog/yoga-asanas-for-lungs/
@sueinmn you wrote, "And I do active breathing with huff coughing during and after exercise (@scoop) – "
Combining clearing with exercise is something I plan to try. Thanks for the suggestion. Before exercise do you neb or use Symbicort only? In my mind I spend too much time clearing. Sometimes clearing feels like a workout in itself! I'm trying to figure out if I can can get the most gunk out in the first 2 tries and then move on with my day. Do you stop during walking to huff cough? It would be great to decrease nebs to 4-5/week but that's not likely even bronch is mild. Too much gunk in the a.m. Do you mind sharing where your bronch is in your lungs? Mine appears to be diffuse.