<a target=_blank class=ftalternatingbarlinklarge href="http://cfcenter.stanford.edu/Meds-Nebs.html">Per the CFF via Stanford</a>
The Cystic Fibrosis Foundation and the Stanford CF Center staff recommend the following sequence for inhaled medications:
Bronchodilators (albuterol, Combiventtm, Xopenextm) to open the airways
Hypertonic Saline (7%) to mobilize mucus and induce airway clearance
Pulmozymetm (DNAse) to thin mucus (Note: studies find no significant differences for order of inhaling DNAse,
hence patient preference can govern timing.)
Airway Clearance Technique: Vest, Fluttertm, chest PT, IPPV, etc.
Antibiotics (TOBItm, Colistin). The previous therapies open and clear the airways of mucus, thereby improving
the distribution and therapeutic impact of these medications.
Steroids (Floventtm, Pulmicorttm, QVARtm)
If you start coughing blood, stop Pulmozinetm, saline, airway clearance technique, and inhaled antibiotics. Call your CF doctor or nurse for further advice.