Proper Order

[ladybug]

Hello!

So, I know there is often some question as to the order in which to do inhaled meds. Well, I recently got a laminated copy of the correct order to do them in from my accredited CF center. I had actually been doing it wrong, so this was very educational to me!

Here it is:

<b>1. Bronchodilator (albuterol or xopenex)

2. Mucolytics (pulmozyme THEN hypertonic saline)

3. Inhaled antibiotic (TOBI or colistin)

4. Long acting bronchodilator (serevent or foradil)

5. Inhaled steroid (flovent, advair, or pulmicort)</b>

Hope this clears up some confusion <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[anonymous]

Very cool~ Thank You!

Did they suggest waiting any amount of time between pulmozyme & hypertoinc saline?
Also, I assume that chest clearance should be done after HS and before TOBI?

 

[ladybug]

No Problem!

They didn't give a wait time between.

As far as chest PT, I do it WITH my albuterol and then do everything else after. I don't think it really matters as long as you're not doing chest PT while doing a medication that should stay in your lungs (such as antibiotics), as this would clearly be counterproductive. Perhaps the albuterol should also stay in the lungs, I don't know... its just how I've always done it.

The vest people (several years ago) told me that doing the vest with meds actually can help the med get deeper into the lungs due to the oscillations of the chest wall. I don't see how this is possible, so I've chosen to do them seperately (except albuterol).

 

[catboogie]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>ladybug</b></i>

Hello!



So, I know there is often some question as to the order in which to do inhaled meds. Well, I recently got a laminated copy of the correct order to do them in from my accredited CF center. I had actually been doing it wrong, so this was very educational to me!



Here it is:



<b>1. Bronchodilator (albuterol or xopenex)



2. Mucolytics (pulmozyme THEN hypertonic saline)



3. Inhaled antibiotic (TOBI or colistin)



4. Long acting bronchodilator (serevent or foradil)



5. Inhaled steroid (flovent, advair, or pulmicort)</b>



Hope this clears up some confusion <img src="i/expressions/face-icon-small-smile.gif" border="0"></end quote></div>



soooo, i do my HS and albuterol together. are they saying one shouldn't do this? also, my doctor said to do TOBI and/or Pulmozyme both after i'd done the HS -- in other words, do the thing that will make you cough the most first (HS) and then do the thing that will make you cough next to most, etc. etc. so that those will be more likely to stay in your lungs. is that crazy?

 

[ladybug]

I always did my H.S. before pulmozyme too... I think this clinic actually originally told me to do it that way. However, they specifically state to do H.S. AFTER pulmo. now. Maybe some new studies came to light? Maybe its just a preference? I don't know. The nurse at our clinic is no longer there, or I'd email and ask her why... Once they train in a new nurse, maybe I'll bring it up. For now, I'll just switch how I do it. I still think its odd to do pulmo. and cough all that out when you do the H.S. I always thought pulmo. should stay in the lungs.... Amy, any ideas on this???

<img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[lightNlife]

Very useful! Thanks. I like having an SOP to follow. It suits my
scientific mind. I'm going to color code mine to match the tags
I've made for my neb cups. That way when I do them all bleary-eyed
in the morning or after a late night, I can still do it
correctly.<br>
<br>
Thanks again!

 

[Ender]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>ladybug</b></i>

I always did my H.S. before pulmozyme too... I think this clinic actually originally told me to do it that way. However, they specifically state to do H.S. AFTER pulmo. now. Maybe some new studies came to light? Maybe its just a preference? I don't know. The nurse at our clinic is no longer there, or I'd email and ask her why... Once they train in a new nurse, maybe I'll bring it up. For now, I'll just switch how I do it. I still think its odd to do pulmo. and cough all that out when you do the H.S. I always thought pulmo. should stay in the lungs.... Amy, any ideas on this???



<img src="i/expressions/face-icon-small-smile.gif" border="0"></end quote></div>

I think the pulmo liquifies it and the HS brings it up. I think using the pulmo first just makes it easier to get all that crap out. It makes sense to me.

That being said, does anyone here at all use mucomyst, and has anyone used mucomyst and pulmozyme? How come no one tries it anymore. I've only heard good things about it.

Wierd

 

[Ender]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>ladybug</b></i>

I always did my H.S. before pulmozyme too... I think this clinic actually originally told me to do it that way. However, they specifically state to do H.S. AFTER pulmo. now. Maybe some new studies came to light? Maybe its just a preference? I don't know. The nurse at our clinic is no longer there, or I'd email and ask her why... Once they train in a new nurse, maybe I'll bring it up. For now, I'll just switch how I do it. I still think its odd to do pulmo. and cough all that out when you do the H.S. I always thought pulmo. should stay in the lungs.... Amy, any ideas on this???



<img src="i/expressions/face-icon-small-smile.gif" border="0"></end quote></div>

I think the pulmo liquifies it and the HS brings it up. I think using the pulmo first just makes it easier to get all that crap out. It makes sense to me.

That being said, does anyone here at all use mucomyst, and has anyone used mucomyst and pulmozyme? How come no one tries it anymore. I've only heard good things about it.

Wierd

 

[mare]

I can't use mucomyst. It caused a major Asthmatic reaction that put me on a ventillator 3 wks ago!
Pulmozyme made me sick, caused hemoptysis, etc. Any suggestions out there for other mucolytics. I am told I cant use HS either because of my Asthma! LOL!!!

 

[anonymous]

I use MucoMyst. Not pulmozyme though.

I just started MucoMyst about a month ago. It has REALLY helped me! The combo of Cromolyn/Mucomyst has helped me more than anything I've been on. I've had no bad reactions to the Mucomyst