DO you do nebs routinely or only when sick?

anonymous

New member
I posted this question on the Families board, but really want to see the opinions of any of the adults out there as well. Have you done routine nebulizer treatments for most of your life and why or why not? Thanks!!

I am the mother of a 17 month old daughter, Hayley, who has CF and I posted the question about CPT and the vest in infant/toddler Cfers. Some of the responses now left me with questions about "routine breathing (neb) treatments". I guess I just assumed that it was the norm and that everyone does the neb treatments all the time, even when healthy, but I am starting to learn that is not the case and I am very curious as to why.

My daughter was diagnosed at 3 months and has been on nebs since then. She does Xopenex 3 times per day and Pulmicort one time per day. She was hospitalized at diagnosis (long story but she was very sick, starting with reflux that aspirated into her lungs, had to have a Nissen and G-Tube, then came the CF diagnosis) But she has been fairly healthy since leaving the hospital. She has had about 4 infections in the last year, all treated with oral Augmentin, which cleared them up. But she does the three breathing treatments per day every day (4 if she is sick). She has only had a throat culture once in the hosptial and cultured Staph. (I plan on asking why they are not doing throat cultures at every visit next week at her clinic visit)

So finally, my question is to everyone, especially those of you with smaller children, what kinds of meds, nebs and CPT do you do with your child? And any information anyone can give me as to why those of you who don't do "routine nebs" can give me on why your doctor does not do them. ALso how oftern does your CF clinic to throat cultures on your child?

Thanks in advance for all replies!!!

Becky, Mom to Nathan, 4 w/o CF and Hayley, 17 months w/CF
 

anonymous

New member
My daughter has been doing albuterol/saline since diagnosis. Right now we do 4 treatments a day, but hopefully after her appontment in Aug, we will move down to 2 or 3. We were doing 4 a day because of an atelectasis in her lower left lobe, which we finally got opened up after a little over a year of 4 treatments a day. We also do pulmozyme once a day, not sure if this will continue or just be done when she is sick (we'll also find that out in Aug). I believe we've done 4 cycles of TOBI.

While I do think that the # of treatments and rather or not it is done permanently or only when sick is decided on the severity of CF, I also think that some DRs use them as a preventative or maintenance, so it could be a DRs chioce rather than a measuring stick for how mild or sever a case is....

Thanks.
Greg
Father of Maddie 18 mo. (tomorrow) w/CF
 

anonymous

New member
I was diagnosed at 2yrs, and since then have been doing nebs and chest thereapy/vest every day ever since. If you think about it, the basic neb doesnt fight lung infection - it helps your lungs to stay clear and keep the mucus from building up too much. Doing the nebs every day helps me from having sick days to begin with - if I only did them when I didn't feel good, it seems like closing the barn door after the cows get out.
I have two nebs I do twice a day: albut, chrom and mucomyst; amikacin (anibiotic). If I am not feeling well, I do a third of the first (but not the second). I also do the vest with the first neb.
As far as cultures, I have always done cultures as far as I can remember. My doctor uses them to keep track of my lung infections and if they are responding to the medicine I am taking.
Things have changed a lot since I was a kid, however, so if there are new routines, I am not aware of them. Sounds like you will be having a good discussion on your next visit to the doctor <img src="i/expressions/face-icon-small-smile.gif" border="0">
Good luck!

barb 33 w/CF
 

anonymous

New member
Thanks for the reply Greg! Sound like we have daughters around the same age! Hayley was born 2-20-04. Thanks again for the information!

Becky
 

anonymous

New member
Thanks for the reply Barb! I am especially always happy to see people in their 30's and above with CF and doing well. I agree with you about the nebs and to continue to do them daily, some people on the family board are saying the only do the nebs when sick because you can buiuld up a resistance to the albuterol/xopenex and then it is not effective, also saying that inhaled steroids such as Pulmicort stunt growth, so it will be interesting to see what other responses I get! We will definitely be having a long discussion at Hayley's birthday visit next week. Thanks again!

Becky
 

blindhearted

New member
I was offically diagnosised at the age of 3 yrs old, but they began to treat me for CF at birth. I always did at least 3 - 4 routine nebs w/ CPT everyday, when I started getting sick I would do treatments at least every 4 hrs while awake.
 
S

SeasonsOfLove

Guest
Becky,

Coll was diagnosed at birth (16 years ago). At that time the doc advised daily PT sessions but no nebs. At about three, she started on albuterol puffers and some time after that, nebs which are done 2-3x daily.

One thing I think you'll find over the years as you deal with CF is that (like the discussion on the family section about whether babies/toddlers should do nebs daily) there's more disagreement over what is the "right" treatment than you would initially imagine. Partially this is because what works for some people doesn't work for others.

Good luck!
 

anonymous

New member
Thanks Kathy! I am begninning to realize that! I guess I thought what we are doing with the daily routine nebs was the norm and that pretty much everyone did it! I guess since we have only been dealing with our CF diagnosis for a little over a year that I am still naive to some of these things!! It's so hard to know which way is the right way (the daily routine nebs or only using nebs when sick), seems like both sides have logical arguments for doing it the way they do it. Guess I will just have to talk to our doctor next week. Thanks again!!! I see posts from you and Coll all the time! I think you have raised an amazing child!!

Becky
 
S

SeasonsOfLove

Guest
Becky,

One other little comment I thought of after posting before - what works treatment-wise during some phases doesn't work during other phases of your child's life. But you sound very on top of things with regard to Hayley so don't worry!

Thanks for your kind words about Coll - I am a lucky Mom indeed!

Take care,
 

Emily65Roses

New member
I have been doing CPT all my life. My parents used to beat me on a regular basis. <img src="i/expressions/face-icon-small-tongue.gif" border="0"> I didn't start daily nebs until I was about 9. That's roughly when Pulmozyme came out on the market. Because pretty much the second it was available, my doc put me on it. And since then, I've done it once a day every day. But I imagine had Pulmozyme been available sooner, I would've been on it sooner.
 

WinAce

New member
Real life often interferes with doing nebulizer treatments, and the like. They're boring as hell, after all. Plus, after a set number of them, you start to get diminishing returns on investment (i.e., "is it really justified to waste SO MUCH ADDITIONAL TIME that could be spent enjoying life, for a mediocre--or often unnoticeable-- improvement the rest of the time?")

Now, I don't buy that logic with CF alone, but everyone's different, and I'm forced to acknowledge I'd just say "screw it" at some absurd point, and focus more on enjoying the time I did have, than trying to put death off by wasting it on treatments. If you had to spend, say, 3 hours a day managing CF, 2 managing diabetes, 3 on managing gastrointestinal side effects, 2 on weight-bearing exercise to improve osteoporosis, 1 on IV antibiotics, and 2 on tube feedings to gain weight, and so on, that wouldn't leave much time for anything else. Granted, no one (I hope...) is stuck in such an unenviable predicament with their health. But when you consider that Real Life(tm) has stuff like school, homework, TV watching, eating, chores, hanging out with friends, and so on--we're already often in the situation of having to choose between a treatment, or something we <i>want</i> to do. The responsible decision is the treatment; the one I wouldn't blame anyone for making is opting for fun, or something perceived as more important (and if given a choice between, say, going to work, or faithfully doing treatments and losing the job--and health coverage--that allows you to pay for them, I'd take the work).
 

anonymous

New member
I definitely agree WinAce. The four treatments a day we are doing now (approx an hour a piece) really cuts into a day! Especially with an 18 month old. We do get the four treatments in the majority of the time, but we also know it is important to let Maddie just be a kid. If we are going to the zoo or out somewhere, she just gets three that day and on occasion just 2 depending on where we are. Also, on our vacation to FL, she just got three a day. Like I said in another post, the 4 treatments were because of an atelectasis and now that it is open, we will hopefully be changed to 2 or 3 a day (Hopefully 2)! Anyway, I guess I'm saying that while the DRs orders are important (especially if sick and not just doing maintenance), but so is living life and not letting CF define you or your family.

Greg
Dad of Maddie 18 mo. old w/CF
 

wuffles

New member
I only do nebs when I am sick, and even then, I don't do them all the time.

I think that my whole life, my parents, my doctors and more recently little ol' me have compromised greatly between being cautious and letting me live a normal life. I took Tobramycin and Ventolin [albuterol] a number of times when I was very young, but only when I was sick. In the past 10 years or so, I can only recall being on nebulised Tobramycin once or twice, when I have been quite sick. Most of my infections are treated with oral antibiotics.

As some people above have said, I'm very glad that my parents and doctors made the decision to leave me those few hours every morning and night free for "normal" kid stuff. Of course, this may have changed the second my lung function decreased [my FEV1 baseline is 100%]. In the future, even if it's shown that I probably should have been using regular nebs for maintenance, I'll still be happy knowing that I was given the chance to act healthy when I was healthy.
 

anonymous

New member
Four years ago my daughter was started on cpt/neb when she was diagnosed at a month old. My nephew was diagnosed a few weeks after my daughter at the age of four. They had (because I later switched) the same cf doctor. My nephew was told he didn't need any cpt/neb treatments because he had never had a lung infection that required hospitalization. They both have double delta 508. This past fall my nephew had his first serious lung infection. He still doesn't do regular cpt/neb treatments even though he did receive the vest after his hospitalization.

I think it is very important to do cpt/neb treatments. It can only help move the mucus in the lungs. My kids both take Pulmozyme and do to breathing treatments a day. They take albuterol when sick. My daughter has a inhaler for Flovent and inhales Mucomist.
Sharon, mom of Sophia, 4 and Jack, 2 both with cf, aunt to Joseph, 8 with cf
 

Justsmurfin

New member
I do nebs every day. I do GSH twice a day and depending on how I'm feeling sometimes I neb foradil and others I use it in the inhaler. When sick I do Atrovent,Xopenex and Atrovent and even after being sick I carry on with that routine for awhile. When I well I use the inhaler version of Pulmicort.

I am neurotic about cleaning my nebulizers and changing tubing so I don't worry about bacteria issues with them. I did get an extremely portable neb that is silent and runs on batteries so I don't feel my life totally revolves around the nebulizer treatments
 

anonymous

New member
My two daughters do albuterol 2x a day/ pulmozyne 1x a day / and TOBI every day for every other month. I really try for the vest at least once a day but that doesnt always happen. But as far as I know, the albuterol opens up the airways and then the pulmozyne breaks up the mucous. The Tobi fights the bacteria that strives in the mucous. CF patients produce mucous (maybe some more than others) but these therapies have always been maintenance to prevent sickness not to treat it!!! Debra
 

JazzysMom

New member
I know that I can hardly be congested (sick) & still have airway restriction. I do an Albuterol neb & bingo I am fine. For me its not just being sick, but the airway maintenance every day that is needed for me to breath at my best.
 
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