Hi cwal, I used the Philips InCourage (tethered to the base machine) for several months, with albuterol then 7% saline in a nebulizer and finishing with spirometry and a PEP. It worked bringing up sputum for a while, then stopped. From what I've read on this site, some folks have good success with postural drainage exercises. These would be tricky to do with a tethered vest. For me, whatever program I follow works only for a while, and then stops. I have noticed that regular exercise can bring up sputum, and so I wonder if mixing it up (i.e., varying air clearance practices and changing stretching/cardio/weight bearing exercise) is what works best most of the time. In a recent post, Sue shared some of her air clearance protocol which I found really interesting. Thus far, I haven't read that using a vest is all one needs to bring up sputum. Good luck!