I use it as my main physiotherapy. I tried the vest but all it did was bounce me around with no result, so I tried this and found it worked a whole lot better. I do my pulmosyme and my albuterol beforehand, then the acapella, then my colistin (or Tobi, whichever you use). Then I do my nasal lavage and Flonase. I can usually get a lot of mucus up with the acapella unless I'm sick, in which case I use either a manual CPT or a high-vibration massager to shake stuff loose, and use the acapella afterwards to get it up.