My daughter who is 5 uses albuterol 3 times a day. We would do an albuterol treatment before her VEST of CPT to open her airways. Now she is on HTS and we do the albuterol first then the HTS. IF we didn't do the albuterol first she would cough like crazy from the HTS. I think it's recommended to do the albuterol first wait 15 min then HTS but we rarely wait just not enough time in the day. Also, I read it's good to do the HTS while doing the VEST but my daughter hates that cause it makes her cough, so we rarely do that as well. Certainly looses stuff out though.