albuterol/levalbuterol inhalation solutions daily use long term

Hello,
I'm also new to bronchiectasis and use Levalbuterol. I started with Albuterol but had too many side effects. Levalbuterol is much better, but I feel so achy and fatigued all of the time. I don't know if it is the infection or the Levalbuterol causing this, but would love advice. Unfortunately, I'm told I'll be using Levalbuterol (or one of those meds) and doing the treatments twice a day for the rest of my life, so I think the answer to your question is yes, it's longterm.

@ling and @mmahlik Many people in this group use either albuterol or levalbuterol nebs daily for a long time. These have been the short-acting beta-agonist drug of choice for opening airways incases of Asthma, Bronchiectasis and other lung disorders for many years, along with Salmeterol.

Three years ago, it was suggested to me, that using the same medication in an inhaler may be as effective for opening airways before 7% saline and airway clearance. I still used the nebulized version during an exacerbation. It worked for me, reducing the bronchospasms I sometimes got from nebulized levalbuterol. I believe some others here also use this method - it cuts about 15 minutes off each airway clearance session.

More recently, my pulmonologist switched me to a generic version of Symbicort, a combination long-acting beta-agonist and inhaled corticosteroid. (formoterol/budesonide) She explained it is the current best protocol for treating long-term moderate asthma, and that the budesonide is less likely to suppress the immune response to bacteria than prednisone.

But the answer to your original question about daily use is -I'm sure there are side effects, but it is prescribed for daily use world-wide and has been for over 40 years and it has saved countless lives (I lost friends in school, my great-grandfather and a 50 year-old neighbor to untreated asthma.)

Thank you Sue for spending the time to explain.
I feel the Levalbuterol solutions help me to do a better job of airway clearance. Maybe they penetrate the small airways better. Do you need to use Breyna even if you use the solutions? I feel my airway clear after using the solutions. It makes me question long term use of solutions only because the doctors prescribe this when we have exacerbations. You are right we can't take asthma lightly.

Ling

I use the Breyna inhaler twice every day, only add levalbuterol nebs during an exacerbation.

My lungs are (currently) quite clear, so I use saline 1-2 week, do airway clearance daily after exercise. All that goes back to twice a day nebs/airway clearance at the first sign of a respiratory infection or other exacerbation. Fortunately that only happenned in 2024 when I had Covid, otherwise I have been doing very well. My pulmonologist called me a "poster child" on how to pay close attention and change up my routine as needed.

Ah, Sue, I am so happy for you that you handle your condition so well. Only saline once or twice a week and airway clearance once a day? That sounds almost like a normal life. After this exacerbation, I am so afraid to catch again. So I am still doing saline twice a day. Even though I don't bring up much mucus any more. Thank you for sharing your successful story.
I hope you continue to thrive!
Ling

Mine was a very gradual & cautious taper - 3 months healthy I dropped back to once a day saline, twice a day clearance.
After no exacerbation for 2 more months, I skipped every 4th day with saline, still twice a day clearance (one after neb, one after exercise.) After a few more months, I dropped the second neb. Then gradually reduced to twice a week nebs.

Each of these changes was okayed by my pulmo, with the understanding I would go back to a full schedule for any exacerbation.

In December, we dropped to twice daily Breyna, 1-2 nebs per week and once a day clearance. So far, so good. Since January of 2023, I have had 2 courses of Prednisone and one of antibiotics.

If you are fortunate enough to have stable Bronchiectasis, no MAC and no illness, it is a wonderful feeling to (cautiously) relax.

Here are the things I DO NOT RELAX - eat well, get proper rest, stay away from sick people, mask at the doctor's office and in crowds, get my vaccinations, avoid indoor pools and spas, use HEPA filters and change them ahead of schedule, and jump on ANY hint of illness within 24 hours. I also use my .2 micron filters, drink filtered or spring water and sanitize/sterilize my equipment faithfully.

Your story is very encouraging. We know what we can achieve. This is really wonderful.

Ling