1. < MAC & Bronchiectasis

Nebulizer and Big 3 questions

Posted by tconz @tconz, Jan 5, 2023

Should Nebulizing Sodium Chloride 7% be used before or after levalbuterol and how many times a day should I use the levalbuterol? Just calling my doctor to try and get off the Spriva and add levalbuterol instead. Also, I am asking for an Aerobika? How is the Aerobika used? I am so new to this and will be a pro one day. LOL I am just starting Big 3 today and took the Azithromycin in the morning without food. Will do this for 4-5 days and then add Ethambutol for 4-5 days and then Rifampin last. Any suggestions are truly appreciated. I am waiting for an appointment time with NJH which will probably be around April.

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Mentor
Sue, Volunteer Mentor | @sueinmn | Jan 5, 2023

@tconz I'm glad to see you are making progress in getting treated and in getting an appointment at NJH.
Levalbuterol or albuterol is inhaled or nebulized before the saline. It opens the airways so the saline penetrates better.
Most people use the Aerobika during or after nebulizing - some attach it to the nebulizer and do it at the same time. Each of us must find what works for their lungs.
Here is my routine:
2 puffs of my inhaler, after 5-10 minutes begin nebbing saline. When the urge to cough becomes overwhelming, put down the neb and do 5 breaths with the Aerobika, huff cough to bring up junk. Repeat neb-Aerobika-cough until the saline is gone or no more mucucs is coming out. This seems to work for me, has kept me off the big 3 for 3 years with only a few minor exacerbations. Before winter set in, with all its respiratory viruses & cold air, I was down to saline every other day but now I am faithful to stay healthy.
Sue

REPLY
1 reply
tconz | @tconz | Jan 5, 2023

This is so helpful and I really appreciate it!

REPLY
sallyb827 | @sallyb827 | Jan 6, 2023
In reply to @sueinmn "@tconz I'm glad to see you are making progress in getting treated and in getting an..." + (show)
@sueinmn

@tconz I'm glad to see you are making progress in getting treated and in getting an appointment at NJH.
Levalbuterol or albuterol is inhaled or nebulized before the saline. It opens the airways so the saline penetrates better.
Most people use the Aerobika during or after nebulizing - some attach it to the nebulizer and do it at the same time. Each of us must find what works for their lungs.
Here is my routine:
2 puffs of my inhaler, after 5-10 minutes begin nebbing saline. When the urge to cough becomes overwhelming, put down the neb and do 5 breaths with the Aerobika, huff cough to bring up junk. Repeat neb-Aerobika-cough until the saline is gone or no more mucucs is coming out. This seems to work for me, has kept me off the big 3 for 3 years with only a few minor exacerbations. Before winter set in, with all its respiratory viruses & cold air, I was down to saline every other day but now I am faithful to stay healthy.
Sue

Jump to this post

I just started all this about a month ago and no one gave me a clear protocol. They told me to nebulize levabuterol, then saline, then Aerobika for 2 breaths, then huff cough. Repeat the Aerobika and huff cough 10 to 15 times. I cough sometimes but never can bring the mucous up.
When using the Aerobika, I thought you inhaled through the Aerobika and then exhaled through it. I then saw a video that showed inhaling normally and then exhaling through the Aerobika.
There is no training and I am frustrated.

REPLY
4 replies
annagh | @annagh | Jan 6, 2023

This is all so helpful. I've been using albuterol, saline 7%, and then AirPhysio device. Just ordered Acapella. Is Aerobika a better choice? I was just diagnosed with MAC, bronchiectasis since 2016. I'm opting to not go on Big 3 since my CT is stable, but am upping the airway clearance.

REPLY
irenea8 | @irenea8 | Jan 7, 2023
In reply to @sallyb827 "I just started all this about a month ago and no one gave me a clear..." + (show)
@sallyb827

I just started all this about a month ago and no one gave me a clear protocol. They told me to nebulize levabuterol, then saline, then Aerobika for 2 breaths, then huff cough. Repeat the Aerobika and huff cough 10 to 15 times. I cough sometimes but never can bring the mucous up.
When using the Aerobika, I thought you inhaled through the Aerobika and then exhaled through it. I then saw a video that showed inhaling normally and then exhaling through the Aerobika.
There is no training and I am frustrated.

Jump to this post

you can inhale and exhale through it or you can just exhale through it. You wait a second after inhaling to exhale. Personally I only exhale through it because it is plastic. But you really can do it either way. I would experiment to see what actually works. I have to do about 16 exhales through it before expelling mucus. And i have to repeat that cycle many times till I feel all the mucus is cleared. Some of those rounds are done lying on my back and sides as well as sitting up. Everyone is different so see what works! I do all this after nebulizing all the saline but again see what works. I tried the Acapella and find the Aerobika more effective.

REPLY
2 replies
sallyb827 | @sallyb827 | Jan 7, 2023
In reply to @irenea8 "you can inhale and exhale through it or you can just exhale through it. You wait..." + (show)
@irenea8

you can inhale and exhale through it or you can just exhale through it. You wait a second after inhaling to exhale. Personally I only exhale through it because it is plastic. But you really can do it either way. I would experiment to see what actually works. I have to do about 16 exhales through it before expelling mucus. And i have to repeat that cycle many times till I feel all the mucus is cleared. Some of those rounds are done lying on my back and sides as well as sitting up. Everyone is different so see what works! I do all this after nebulizing all the saline but again see what works. I tried the Acapella and find the Aerobika more effective.

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Thank you so much! That is very helpful information!

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irenea8 | @irenea8 | Jan 7, 2023

I should also add that if you feel the need to cough out mucus during Saline nebulizing then of course do so. For me it just starts to come up during nebulizing without the Aerobika which i use afterwards. For others you may find that using the Aerobika during nebulizing works for you. Either attached to the nebulizer or used off and on during the nebulizing process. Whatever gets it out!

REPLY
pw | @pawster | Mar 21, 2023
In reply to @sallyb827 "I just started all this about a month ago and no one gave me a clear..." + (show)
@sallyb827

I just started all this about a month ago and no one gave me a clear protocol. They told me to nebulize levabuterol, then saline, then Aerobika for 2 breaths, then huff cough. Repeat the Aerobika and huff cough 10 to 15 times. I cough sometimes but never can bring the mucous up.
When using the Aerobika, I thought you inhaled through the Aerobika and then exhaled through it. I then saw a video that showed inhaling normally and then exhaling through the Aerobika.
There is no training and I am frustrated.

Jump to this post

I started out similarly watching videoes online trying to figure things out. After asking my doctor. I received one-on-one help from a respiratory therapist (zoom meeting as my Dr is a long ways off) Asking for one or even more visits with respiratory therapist certainly helped me out.

REPLY
pw | @pawster | Mar 21, 2023
In reply to @irenea8 "you can inhale and exhale through it or you can just exhale through it. You wait..." + (show)
@irenea8

you can inhale and exhale through it or you can just exhale through it. You wait a second after inhaling to exhale. Personally I only exhale through it because it is plastic. But you really can do it either way. I would experiment to see what actually works. I have to do about 16 exhales through it before expelling mucus. And i have to repeat that cycle many times till I feel all the mucus is cleared. Some of those rounds are done lying on my back and sides as well as sitting up. Everyone is different so see what works! I do all this after nebulizing all the saline but again see what works. I tried the Acapella and find the Aerobika more effective.

Jump to this post

The only part that surprises me is lying on your back. I need to be upright during inhaling or choke. As you said so well everyone is different.

REPLY
1 reply
pacathy | @pacathy | Mar 21, 2023
In reply to @sallyb827 "I just started all this about a month ago and no one gave me a clear..." + (show)
@sallyb827

I just started all this about a month ago and no one gave me a clear protocol. They told me to nebulize levabuterol, then saline, then Aerobika for 2 breaths, then huff cough. Repeat the Aerobika and huff cough 10 to 15 times. I cough sometimes but never can bring the mucous up.
When using the Aerobika, I thought you inhaled through the Aerobika and then exhaled through it. I then saw a video that showed inhaling normally and then exhaling through the Aerobika.
There is no training and I am frustrated.

Jump to this post

I just had pt ed the pt Ed. She told me to breath in a bit deeper than normal, but exhale longer and with a bit more power than usual. She had me do both thru Aerobika, but it's the exhale that's important.
The instructions on p 3-4 in instruction booklet mirror what she told me.
Good luck.

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