Dr. Advised Hypertonic THEN Pulmozyme

[Lizbeth]

At my last appointment my doctor advised starting w/ HS then doing Pulmozyme. Previously I have done the reversed order. Apparently there is a new study that states HS followed by Pulmozyme may be more effective.

I saw the study but the sample size was fairly small.

Just curious if anyone else is doing this and if you have had better results?

Lizbeth

 

[Lizbeth]

At my last appointment my doctor advised starting w/ HS then doing Pulmozyme. Previously I have done the reversed order. Apparently there is a new study that states HS followed by Pulmozyme may be more effective.

I saw the study but the sample size was fairly small.

Just curious if anyone else is doing this and if you have had better results?

Lizbeth

 

[Lizbeth]

At my last appointment my doctor advised starting w/ HS then doing Pulmozyme. Previously I have done the reversed order. Apparently there is a new study that states HS followed by Pulmozyme may be more effective.

I saw the study but the sample size was fairly small.

Just curious if anyone else is doing this and if you have had better results?

Lizbeth

 

[BaylorCrew07]

never heard of that, but i have an appt. tomorrow morning, so i'll be sure to ask my doc <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[BaylorCrew07]

never heard of that, but i have an appt. tomorrow morning, so i'll be sure to ask my doc <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[BaylorCrew07]

never heard of that, but i have an appt. tomorrow morning, so i'll be sure to ask my doc <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[Alyssa]

My daughter does HS first then Pulmozyme -- we thought that's what they said to do -- It's our understanding that usually the rule of thumb is do everything that causes dilation, coughing and clearing to happen first, then do the things that you want to "stay" in the lungs last (like Pulmozyme & Tobi)

 

[Alyssa]

My daughter does HS first then Pulmozyme -- we thought that's what they said to do -- It's our understanding that usually the rule of thumb is do everything that causes dilation, coughing and clearing to happen first, then do the things that you want to "stay" in the lungs last (like Pulmozyme & Tobi)

 

[Alyssa]

My daughter does HS first then Pulmozyme -- we thought that's what they said to do -- It's our understanding that usually the rule of thumb is do everything that causes dilation, coughing and clearing to happen first, then do the things that you want to "stay" in the lungs last (like Pulmozyme & Tobi)

 

[lightNlife]

Interesting. Do you know what the study was? According to all the literature I've read (and also asking my doctor about it) this is the preferred order of operations:

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)

Here's why the order of operations is so important when managing CF.

The bronchodilator helps open up the airways. The more open the airways, the better the chances of inhaling the other medications deeply enough into the lungs where they can be most effective. Mucolytics are "mucus cutting" medications. They help break up the secretions so that they can be coughed up more easily. In CF patients, the mucus and the lungs are typically dry, which is why hypertonic saline is so useful. Hypertonic saline works by adding moisture to the lining of the lungs, resulting in a slippery surface conducive coughing out sputum. Following sputum clearance of the airways, the lungs are further able to take in the nebulized mist of the antibiotics. At this point there is a greater likelihood of the antibiotics taking hold in both small and large airways. The treatment concludes with inhaled steroids which help keep the airways open for an extended period of time (i.e. 8-12 hours when it is time for another treatment.)

 

[lightNlife]

Interesting. Do you know what the study was? According to all the literature I've read (and also asking my doctor about it) this is the preferred order of operations:

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)

Here's why the order of operations is so important when managing CF.

The bronchodilator helps open up the airways. The more open the airways, the better the chances of inhaling the other medications deeply enough into the lungs where they can be most effective. Mucolytics are "mucus cutting" medications. They help break up the secretions so that they can be coughed up more easily. In CF patients, the mucus and the lungs are typically dry, which is why hypertonic saline is so useful. Hypertonic saline works by adding moisture to the lining of the lungs, resulting in a slippery surface conducive coughing out sputum. Following sputum clearance of the airways, the lungs are further able to take in the nebulized mist of the antibiotics. At this point there is a greater likelihood of the antibiotics taking hold in both small and large airways. The treatment concludes with inhaled steroids which help keep the airways open for an extended period of time (i.e. 8-12 hours when it is time for another treatment.)

 

[lightNlife]

Interesting. Do you know what the study was? According to all the literature I've read (and also asking my doctor about it) this is the preferred order of operations:

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)

Here's why the order of operations is so important when managing CF.

The bronchodilator helps open up the airways. The more open the airways, the better the chances of inhaling the other medications deeply enough into the lungs where they can be most effective. Mucolytics are "mucus cutting" medications. They help break up the secretions so that they can be coughed up more easily. In CF patients, the mucus and the lungs are typically dry, which is why hypertonic saline is so useful. Hypertonic saline works by adding moisture to the lining of the lungs, resulting in a slippery surface conducive coughing out sputum. Following sputum clearance of the airways, the lungs are further able to take in the nebulized mist of the antibiotics. At this point there is a greater likelihood of the antibiotics taking hold in both small and large airways. The treatment concludes with inhaled steroids which help keep the airways open for an extended period of time (i.e. 8-12 hours when it is time for another treatment.)

 

[BaylorCrew07]

yeah, I had heard pulmozyme first because it thins the mucus, so when you take HS it is easier to cough up and get rid of the mucus since it's thinner. I'd like to see the study as well, if you have a link to it or anything. Maybe I can bring it to my appt. tomorrow, but regardless I'm going to ask my dr. about it; hopefully she's heard of it.

 

[BaylorCrew07]

yeah, I had heard pulmozyme first because it thins the mucus, so when you take HS it is easier to cough up and get rid of the mucus since it's thinner. I'd like to see the study as well, if you have a link to it or anything. Maybe I can bring it to my appt. tomorrow, but regardless I'm going to ask my dr. about it; hopefully she's heard of it.

 

[BaylorCrew07]

yeah, I had heard pulmozyme first because it thins the mucus, so when you take HS it is easier to cough up and get rid of the mucus since it's thinner. I'd like to see the study as well, if you have a link to it or anything. Maybe I can bring it to my appt. tomorrow, but regardless I'm going to ask my dr. about it; hopefully she's heard of it.

 

[AnD]

I was going to start a thread on this, since I had asked a similar question a little while ago, but I'll just post here instead <img src="i/expressions/face-icon-small-wink.gif" border="0"> . My dr. advised Xopenex (refined albuterol), pulmozyme, wait 15 min., HS, advair, and then (and this part may just be for me <img src="i/expressions/face-icon-small-wink.gif" border="0"> ) I do my inhaled antibiotic last, as the advair keeps me from having an airway irritation reaction with Tobi.

I experimented with pulmozyme or HS first, and I get more up and stay clearer all day if I do the Pulmozyme first, wait the 15 min., and then do the HS <img src="i/expressions/face-icon-small-smile.gif" border="0"> .

 

[AnD]

I was going to start a thread on this, since I had asked a similar question a little while ago, but I'll just post here instead <img src="i/expressions/face-icon-small-wink.gif" border="0"> . My dr. advised Xopenex (refined albuterol), pulmozyme, wait 15 min., HS, advair, and then (and this part may just be for me <img src="i/expressions/face-icon-small-wink.gif" border="0"> ) I do my inhaled antibiotic last, as the advair keeps me from having an airway irritation reaction with Tobi.

I experimented with pulmozyme or HS first, and I get more up and stay clearer all day if I do the Pulmozyme first, wait the 15 min., and then do the HS <img src="i/expressions/face-icon-small-smile.gif" border="0"> .

 

[AnD]

I was going to start a thread on this, since I had asked a similar question a little while ago, but I'll just post here instead <img src="i/expressions/face-icon-small-wink.gif" border="0"> . My dr. advised Xopenex (refined albuterol), pulmozyme, wait 15 min., HS, advair, and then (and this part may just be for me <img src="i/expressions/face-icon-small-wink.gif" border="0"> ) I do my inhaled antibiotic last, as the advair keeps me from having an airway irritation reaction with Tobi.

I experimented with pulmozyme or HS first, and I get more up and stay clearer all day if I do the Pulmozyme first, wait the 15 min., and then do the HS <img src="i/expressions/face-icon-small-smile.gif" border="0"> .

 

[Lizbeth]

I don't have the study so please do ask at your next appointments.

I think that the new thought is that you want the pulmozyme to get to the hard to get to gunk in your lungs. So you clear out everything that comes out easily with the HS and THEN get the pulmozyme on what remains. If you do the reverse order then you are just going to cough out all of the pulmozyme as soon as you start the HS.

I am not saying either way is right or wrong. Just want to let everyone know that this is the "new" thought process with the order of medications...at least according to my CF doctor at The Baylor Clinic in Houston.

 

[Lizbeth]

I don't have the study so please do ask at your next appointments.

I think that the new thought is that you want the pulmozyme to get to the hard to get to gunk in your lungs. So you clear out everything that comes out easily with the HS and THEN get the pulmozyme on what remains. If you do the reverse order then you are just going to cough out all of the pulmozyme as soon as you start the HS.

I am not saying either way is right or wrong. Just want to let everyone know that this is the "new" thought process with the order of medications...at least according to my CF doctor at The Baylor Clinic in Houston.