Elaine @ainekrech
You've received good suggestions here and I will add a few.

1. Have you tried 7% saline instead of the 3% in your nebulizer? It takes getting used to but many prefer it.

2, If you are not already, try taking NAC and mucinex with a full glass of water prior to clearing. Sipping on warm/hot water can be helpful also.

3. It seems you are on a lot of albuterol. Maybe you're also treating asthma? Some people prefer levalbuterol, (less shakiness).

4. Try rinsing nose with saline along with budesonide 0.5mg/2mL in the a.m. rinse bottle (script required) instead of Flonase. If that doesn't help with congestion/stuffiness try Xhance (also Rx).

5. Sometimes sinusitis can be exacerbated by reflux/gerd. Sleeping on wedge and avoid food/drink 4 hours before helps. Have you tried a PPI?

6. If you're allergic have you tried allegra to help with congestion? Do you know what you're allergic to?

7. Agree with others - don't treat an exacerbation without a culture

Personally, I would avoid another surgery unless there is some structural issue. Bronchiectasis, sinusitis and GERD/reflux are all connected. One gets bad and they all get bad or worse.