Airway clearance successful techniques

My pulmonologist suggested that getting into a position with your legs higher than your chest will aid drainage. Then you can cough it up. Make sure you have a cup handy. OBTW, do this after your nebulizer therapy.

@susanocl
Hi, just wondering if you were on the Big 3 at some point and that's how you got to the negative for MAC. I was diagnosed almost 3 years ago but have not started any meds and don't do airway clearance etc. because I have very few issues. I do cough up some mucus in the morning, but not much. I'm wondering if when I see my pulmo Dr. in Dec. if I should ask to start the airway clearance/nebulizing. Those are two different steps, correct? Thank you so much. Also, I just found out that I do not have lung cancer, the nodules have gotten smaller.

@sheila7a

You don't have to suck your cheeks in, just keep them in a neutral position. Maybe you're blowing too hard or you need to change the setting on your device.

@bbeers I have never done the Big 3. Two years of CT scans and two broncoscopy and never a definitive diagnosis. It "looked" like MAC with tree in bud nodules but 2 broncs were negative. Third bronc and first sputum test this May 2025 were both positive for MAC. (I'd had double pneumonia twice in Feb. and March). Met with Infec. Dis Dr at Mayo and he said it wasn't severe enough to treat at this time. Side effects could be worse. I'd started airway clearance 2x per day in May and after mtg with ID in July I upped to 7% saline (based on my research and request to ID - who relayed that to my pulm). The nebulizing is part of the airway clearance routine. Mine includes nebulizing levalbuteral (doesn't make me as shaky as albuterol), neb saline 7%, and then Bevespi inhaler. That all takes some time but I do it while watching TV at night and got a 2nd of everything to keep at work and do it while reading email and catching up on Teams in the mornings. Fortunately I have an office where I can close the door. Yay for you for no LC!!! Prayers for continued positive there! I've recently backed down to 1x per day on some days.... when busy. Praying my next sputum test this week will stay negative. Takes 45 days to "grow" and get results. I did push my ID to do sputum test every 3 months... he wanted to go 6 or 12. I want to make sure I stay negative or very low bacteria load.

@lvnl same here. I sip while nebulizer if need to. It eases the irritation but then I can usually do a cough after and get some up as well. During the day inbetween it's important to keep well hydrated! Hydrate hydrate hydrate
Exercise exercise exercise
That's what I remind myself of all the time!

@sheila7a
Your cheeks should not puff out to get full effect

Newbie here, diagnosed with BE last June 2025, figuring out airway clearance, etc. I have a vest which helps so much. My pulmo wants me to neb 7% saline. I'm reading that this will help, but I'm nervous to try it, afraid I will get an asthma flareup. If you have asthma and prone to flareups in higher humidity, what is your experience? Many thanks, this is a wonderful forum!

@clinenan Have you tried nebbing with a lower concentration of saline to see how your lungs react?

Years ago I started with .9% (normal) saline vials and they worked fine. While I was being treated for MAC in 2018 & 2019 7% saline became popular, but my pulmonologist was hesitant because of limited data and my asthma, so we tried 3% and it was fine too.

At the end of 2019, I stopped antibiotics and transitioned to 7% saline (at first diluting it with 3% and working up to straight 7%.) I also used levalbuterol nebs first to avoid a bronchospasm from the saline. A few years later, I was transitioned to Symbicort (generic) for my asthma, which was a life-changer for me. The asthma flares from weather and pollen are gone, and I only need asthma nebs when ill (like when I had Covid in 2024.)

For the past 6 years, I have continued with Symbicort, occasional 7% saline & daily airway clearance (exercise gets my mucus out) and have been MAC free, with stable BE and stable asthma.

Maybe you can talk to the doc about a trial - ramping up as far as you tolerate?

@clinenan Welcome to this wonderful supportive group! Asthma here too. I find 2 puffs of albuterol 10 minutes before nebulizing with 7% saline helps a lot, as does sipping something warm (herbal tea or water) while nebulizing. Frequent breaks are helpful. During those breaks perform some huff coughs in the hopes of expelling built up phlegm.

One of my favorite videos for learning to do the huff cough

@sueinmn, @scoop, thank you for your great advice. I thought about using albuterol beforehand, will consider it. I do have some OTC .9% 5mg saline vials, will that do for a starter, or does it need to be Rx/hypertonic? I will talk to my pulmo about a slower ramp up.