My dr instructed me to do Albuterol first, wait about 4 or 5 minutes and then nebulize. The Albuterol helps open the airways so the saline can go deeper. Seems to work just fine for me. Also, when nebbing, I use my Aerobika which hooks right up to the nebulizer. And, when I am done with that, I do my compression vest for 20 minutes. Best of luck to you.