We do saline before the first vest treatment of the day. We used to do pulmozyme before, but we recently switched to after the second treatment. Doc says that it's a slower acting drug and works better if you do it at night, let it sit, and then it does it's thing during the next morning's treatment. Hard to tell if it does anything different as Sophie doesn't have a persistent cough. We do saline at the same time as the vest if we're crunched for time, but do it consecutively if we have time. More time to let it get in the lungs, and more time jiggling at full effect.