Dr. Advised Hypertonic THEN Pulmozyme

[cf4life]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>cf4life</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Lizbeth</b></i>



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.

</end quote></div>





The other way to look at it is if you do the HS first then you cough out most of the junk so that the pulmozyme can get deeper into your lungs to work to work on the tougher mucus. If you are worried about coughing the pulmo up, make sure you wait 15-20 minutes before you do the HS, that should be enough to do its job. I guess if you want to be extra thorough, do HS then pulmo then waith, then do more HS. </end quote></div>


I realized we are saying the same thing. I guess after reading the posts I got confused on who was saying what. HS than Pulmo is what I do and my doctor supports. I think this makes sense as stated above.

 

[cf4life]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>cf4life</b></i>

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Lizbeth</b></i>



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.

</end quote></div>





The other way to look at it is if you do the HS first then you cough out most of the junk so that the pulmozyme can get deeper into your lungs to work to work on the tougher mucus. If you are worried about coughing the pulmo up, make sure you wait 15-20 minutes before you do the HS, that should be enough to do its job. I guess if you want to be extra thorough, do HS then pulmo then waith, then do more HS. </end quote></div>


I realized we are saying the same thing. I guess after reading the posts I got confused on who was saying what. HS than Pulmo is what I do and my doctor supports. I think this makes sense as stated above.

 

[cf4life]

Just wanted to add that I use the vest in between HS and Pulmo, not after.

DuoNeb, HS, Vest, Pulmo, Tobi

 

[cf4life]

Just wanted to add that I use the vest in between HS and Pulmo, not after.

DuoNeb, HS, Vest, Pulmo, Tobi

 

[cf4life]

Just wanted to add that I use the vest in between HS and Pulmo, not after.

DuoNeb, HS, Vest, Pulmo, Tobi

 

[NoExcuses]

I'm just wary of rumors of "my doc said this" and "my doc said that" that can be started on this site.

Whenever I post anything new about CF research, I always try to accompany it by a published study or article. I realize I dont' always because it's not always possible. But I think none of us should alter what we do until we see studies with our own eyes.

 

[NoExcuses]

I'm just wary of rumors of "my doc said this" and "my doc said that" that can be started on this site.

Whenever I post anything new about CF research, I always try to accompany it by a published study or article. I realize I dont' always because it's not always possible. But I think none of us should alter what we do until we see studies with our own eyes.

 

[NoExcuses]

I'm just wary of rumors of "my doc said this" and "my doc said that" that can be started on this site.

Whenever I post anything new about CF research, I always try to accompany it by a published study or article. I realize I dont' always because it's not always possible. But I think none of us should alter what we do until we see studies with our own eyes.

 

[princessjdc]

I have always done Pulmozyme first and then hypertonic saline, simply because of the pulmo thinning the mucous so that I can cough up the mucous during hypertonic saline or vest.

I do my combivent then my advair then pulmozyme then hypertonice saline then the vest and then Ill do tobi very last when Im on it. By doing Tobi last then I would have my airways open and cleared out for Tobi to go down deep into my airways. Its always made sense to me that way. Never thought about switching and having HS first then Pulmo, if you think about it, it could go either way, and work the same way. Any who Im sticking with my original order, good post though.

I never have asked my doc which order would be best when I started hs I just figured it would be more logical to do hs after pulmo. Maybe I should ask him and see what he says.

 

[princessjdc]

I have always done Pulmozyme first and then hypertonic saline, simply because of the pulmo thinning the mucous so that I can cough up the mucous during hypertonic saline or vest.

I do my combivent then my advair then pulmozyme then hypertonice saline then the vest and then Ill do tobi very last when Im on it. By doing Tobi last then I would have my airways open and cleared out for Tobi to go down deep into my airways. Its always made sense to me that way. Never thought about switching and having HS first then Pulmo, if you think about it, it could go either way, and work the same way. Any who Im sticking with my original order, good post though.

I never have asked my doc which order would be best when I started hs I just figured it would be more logical to do hs after pulmo. Maybe I should ask him and see what he says.

 

[princessjdc]

I have always done Pulmozyme first and then hypertonic saline, simply because of the pulmo thinning the mucous so that I can cough up the mucous during hypertonic saline or vest.

I do my combivent then my advair then pulmozyme then hypertonice saline then the vest and then Ill do tobi very last when Im on it. By doing Tobi last then I would have my airways open and cleared out for Tobi to go down deep into my airways. Its always made sense to me that way. Never thought about switching and having HS first then Pulmo, if you think about it, it could go either way, and work the same way. Any who Im sticking with my original order, good post though.

I never have asked my doc which order would be best when I started hs I just figured it would be more logical to do hs after pulmo. Maybe I should ask him and see what he says.

 

[ladybug]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>lightNlife</b></i>

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.)</end quote></div>

This is the exact order my CF clinic has me (and everyone else) doing meds in and for essentially the same reasons. My clinic went so far as to print out and laminate the order to give to all CF patients. Do they have research to support this theory? I would hope so. Or, possibly, they're just going on the logical explanation that thinned out mucus is easier to cough out with HS than HS and then trying to thin out what's left. I don't know. It made sense when they told me, and I've never been told different, so that's how I'll do it. If there is research somewhere to support the contrary, I too would be interested, but for me pulmo. THEN H.S. makes a bit more sense when you think what each of these solutions is supposed to do.

Good luck getting your hands on that research! I may also try to contact my clinic and see if they can point to why they suggest the opposite order (pulmo. then H.S.), but it may take a bit to hear back. <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[ladybug]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>lightNlife</b></i>

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.)</end quote></div>

This is the exact order my CF clinic has me (and everyone else) doing meds in and for essentially the same reasons. My clinic went so far as to print out and laminate the order to give to all CF patients. Do they have research to support this theory? I would hope so. Or, possibly, they're just going on the logical explanation that thinned out mucus is easier to cough out with HS than HS and then trying to thin out what's left. I don't know. It made sense when they told me, and I've never been told different, so that's how I'll do it. If there is research somewhere to support the contrary, I too would be interested, but for me pulmo. THEN H.S. makes a bit more sense when you think what each of these solutions is supposed to do.

Good luck getting your hands on that research! I may also try to contact my clinic and see if they can point to why they suggest the opposite order (pulmo. then H.S.), but it may take a bit to hear back. <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[ladybug]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>lightNlife</b></i>

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.)</end quote></div>

This is the exact order my CF clinic has me (and everyone else) doing meds in and for essentially the same reasons. My clinic went so far as to print out and laminate the order to give to all CF patients. Do they have research to support this theory? I would hope so. Or, possibly, they're just going on the logical explanation that thinned out mucus is easier to cough out with HS than HS and then trying to thin out what's left. I don't know. It made sense when they told me, and I've never been told different, so that's how I'll do it. If there is research somewhere to support the contrary, I too would be interested, but for me pulmo. THEN H.S. makes a bit more sense when you think what each of these solutions is supposed to do.

Good luck getting your hands on that research! I may also try to contact my clinic and see if they can point to why they suggest the opposite order (pulmo. then H.S.), but it may take a bit to hear back. <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[gsplover]

When my Doc came back from the Denver convention he mentioned the same thing, HS and then Pulmozyme. I tole him I always do the Pulmozyme first and HS second. He said to do what I was comfortable with because the really in no evidence that one way is better than the other. Just mnake sure you are using two different nebs for each of these medications.

 

[gsplover]

When my Doc came back from the Denver convention he mentioned the same thing, HS and then Pulmozyme. I tole him I always do the Pulmozyme first and HS second. He said to do what I was comfortable with because the really in no evidence that one way is better than the other. Just mnake sure you are using two different nebs for each of these medications.

 

[gsplover]

When my Doc came back from the Denver convention he mentioned the same thing, HS and then Pulmozyme. I tole him I always do the Pulmozyme first and HS second. He said to do what I was comfortable with because the really in no evidence that one way is better than the other. Just mnake sure you are using two different nebs for each of these medications.

 

[AnD]

Since I do the xopenex, pulmozyme, HS, advair, Tobi (or colistin), my dr. wanted me to specificly wait 15 mins. between the pulmozyme and the HS to give the pulmozyme a chance to work <img src="i/expressions/face-icon-small-wink.gif" border="0"> . And yes, said to wait at least 15 min after the xopenex to do the hs, too <img src="i/expressions/face-icon-small-wink.gif" border="0"> .

 

[AnD]

Since I do the xopenex, pulmozyme, HS, advair, Tobi (or colistin), my dr. wanted me to specificly wait 15 mins. between the pulmozyme and the HS to give the pulmozyme a chance to work <img src="i/expressions/face-icon-small-wink.gif" border="0"> . And yes, said to wait at least 15 min after the xopenex to do the hs, too <img src="i/expressions/face-icon-small-wink.gif" border="0"> .

 

[AnD]

Since I do the xopenex, pulmozyme, HS, advair, Tobi (or colistin), my dr. wanted me to specificly wait 15 mins. between the pulmozyme and the HS to give the pulmozyme a chance to work <img src="i/expressions/face-icon-small-wink.gif" border="0"> . And yes, said to wait at least 15 min after the xopenex to do the hs, too <img src="i/expressions/face-icon-small-wink.gif" border="0"> .