Hmmm, well, with the agreement of my pulmonologist, I skip the albuterol neb (that's what makes me shaky) unless I am having an asthma attack or an exacerbation (infection, cold, etc.)

According to my pulmo, the Symbicort inhaler can effectively be used in place of albuterol for asthma control for many people. I have been using it twice a day for one year, and it has been a "game changer." The combination of budosenide (a corticosteroid) and formoterol (long-acting beta agonist) is meant to provide both long-term control & can be used one extra time for short-term relief on difficult days. Albuterol ( a short-acting beta agonist), is meant to immediately relieve wheezing & open airways, but is only effective for a few hours. I have not used the full contents of one levalbuterol inhaler, nor more than a dozen saline ampules, since I began Symbicort last June.

So I use my Symbicort first thing in the morning, then go about my routine. I neb saline anytime at least 20 minutes later. According to my doc, by then the mist has been as fully absorbed by my lung tissue as it is going to be, there is no danger of washing away.

Sue