HTS prior to Pulmozyme

[cf4life]

I hardly ever have any break in between. I can tell a difference when I do the pulmozyme and times when I don't so something must be working. At times if I am out of clean/sterile nebs I will even use the same empty neb. I think even with the trio eflow they tell you to just do them in the same neb right after each other. I'd be interested if anyone has a link to a study of some type. Sometimes these things are more theories that get started and get taken as fact.

kitomd21 - the 3% comes in 15ml vials. I don't know if you can get it any another way. Most neb the 7%, which you have to mix or use the pari hyper-sal. I think 3-5ml is typically what one nebs at a time.

 

[cheygemini]

<br>I was just told at our last appointment that now we only have to wait 10 mins after HyperSal to do Pulmozyme. We go to UCSF and our doctor said this wasbased on new information. I guess the saline doesn't stay active for very long. Still, I usually try to wait at least 15 minutes. Willowmom to Cheyenne, age 6 withDF508/N1303K

 

[cheygemini]

<br>I was just told at our last appointment that now we only have to wait 10 mins after HyperSal to do Pulmozyme. We go to UCSF and our doctor said this wasbased on new information. I guess the saline doesn't stay active for very long. Still, I usually try to wait at least 15 minutes. Willowmom to Cheyenne, age 6 withDF508/N1303K

 

[cheygemini]

<br>I was just told at our last appointment that now we only have to wait 10 mins after HyperSal to do Pulmozyme. We go to UCSF and our doctor said this wasbased on new information. I guess the saline doesn't stay active for very long. Still, I usually try to wait at least 15 minutes. Willowmom to Cheyenne, age 6 withDF508/N1303K

 

[hmw]

We do the hypersal in the morning as it's a particularly good tx for her to break up any junk she's accumulated overnight and again during the day if she's doing more than 2tx/day at the time. Her dr likes pulmozyme at night as it's longer-acting. We don't do the two during the same session, but even if it's now considered ok with a break I don't think I'd want to, since her tx take nearly an hour as it is.

 

[hmw]

We do the hypersal in the morning as it's a particularly good tx for her to break up any junk she's accumulated overnight and again during the day if she's doing more than 2tx/day at the time. Her dr likes pulmozyme at night as it's longer-acting. We don't do the two during the same session, but even if it's now considered ok with a break I don't think I'd want to, since her tx take nearly an hour as it is.

 

[hmw]

We do the hypersal in the morning as it's a particularly good tx for her to break up any junk she's accumulated overnight and again during the day if she's doing more than 2tx/day at the time. Her dr likes pulmozyme at night as it's longer-acting. We don't do the two during the same session, but even if it's now considered ok with a break I don't think I'd want to, since her tx take nearly an hour as it is.

 

[LKBamberg]

Here's my two cents.

Hypersaline will evacuate water from the lung tissue. IOW, if you have medication in your lungs (such as tobramycin or pulmozyme) the medication can be evacuated with the water.

This will not happen immediately; my guess would it would take at least 10 minutes. As far as salt damaging the pulmozyme, I can believe it. It damages the antibiotic and the albuterol. Watch what happens if you mix the two, or simply don't rinse your neb cup between alberterol and hypersal.

I do my pulmozyme in the morning. This is when mucous (for me at least) is thickest and stickiest from all night of not coughing or exercising. Being a DNAse, pulmozyme is most effective against the mucous itself. Hypersaline and antibiotics work best with cleared lungs. So I do a morning treatment with just pulmozyme, then an afternoon and night with hypersaline.

 

[LKBamberg]

Here's my two cents.

Hypersaline will evacuate water from the lung tissue. IOW, if you have medication in your lungs (such as tobramycin or pulmozyme) the medication can be evacuated with the water.

This will not happen immediately; my guess would it would take at least 10 minutes. As far as salt damaging the pulmozyme, I can believe it. It damages the antibiotic and the albuterol. Watch what happens if you mix the two, or simply don't rinse your neb cup between alberterol and hypersal.

I do my pulmozyme in the morning. This is when mucous (for me at least) is thickest and stickiest from all night of not coughing or exercising. Being a DNAse, pulmozyme is most effective against the mucous itself. Hypersaline and antibiotics work best with cleared lungs. So I do a morning treatment with just pulmozyme, then an afternoon and night with hypersaline.

 

[LKBamberg]

Here's my two cents.

Hypersaline will evacuate water from the lung tissue. IOW, if you have medication in your lungs (such as tobramycin or pulmozyme) the medication can be evacuated with the water.

This will not happen immediately; my guess would it would take at least 10 minutes. As far as salt damaging the pulmozyme, I can believe it. It damages the antibiotic and the albuterol. Watch what happens if you mix the two, or simply don't rinse your neb cup between alberterol and hypersal.

I do my pulmozyme in the morning. This is when mucous (for me at least) is thickest and stickiest from all night of not coughing or exercising. Being a DNAse, pulmozyme is most effective against the mucous itself. Hypersaline and antibiotics work best with cleared lungs. So I do a morning treatment with just pulmozyme, then an afternoon and night with hypersaline.

 

[schmj4910]

We have been told to do this order: Albuterol, Hypertonic Saline, Pulmozyme. We do it all (twice a day) while doing the vest. We haven't been told to take any breaks between products. I read over the instructions we got and it did not say to wait any period of time between saline and Pulmozyme.

I use the same neb cup for the saline and the Pulmozyme. I just shake out any excess saline. I'm lazy and don't want to wash four neb cups a day. I checked with our Pulmo nurse and she said it would be ok to do this.

We use the 3% Hypertonic Saline. Ours also comes in 15 ml vials. At first, we were told to use 4 mls and keep the rest of the vial for later uses. I didn't like that idea and called the Pulmo nurse, who assured me it was ok. Mysteriously, when it was time to renew our prescription, we found that it is now written for a new vial every day! So, actually, what I do is I squirt in about 6 mls (I look at the measurements on the side of the neb cup) and then whatever is left after 15 minutes I just dump out. I like thinking that he is getting a strong, thick mist rather than sputtering at the end. And since we throw the vial out anyway...who cares if it is wasted? But typically the dose is 4 ml per session.

If you can, try to get your clinic to write the prescription so that you can use a new vial for every session, or at least every day (using the same vial for two sessions). I read that Pseudomonas can grow in saline, too.

 

[schmj4910]

We have been told to do this order: Albuterol, Hypertonic Saline, Pulmozyme. We do it all (twice a day) while doing the vest. We haven't been told to take any breaks between products. I read over the instructions we got and it did not say to wait any period of time between saline and Pulmozyme.

I use the same neb cup for the saline and the Pulmozyme. I just shake out any excess saline. I'm lazy and don't want to wash four neb cups a day. I checked with our Pulmo nurse and she said it would be ok to do this.

We use the 3% Hypertonic Saline. Ours also comes in 15 ml vials. At first, we were told to use 4 mls and keep the rest of the vial for later uses. I didn't like that idea and called the Pulmo nurse, who assured me it was ok. Mysteriously, when it was time to renew our prescription, we found that it is now written for a new vial every day! So, actually, what I do is I squirt in about 6 mls (I look at the measurements on the side of the neb cup) and then whatever is left after 15 minutes I just dump out. I like thinking that he is getting a strong, thick mist rather than sputtering at the end. And since we throw the vial out anyway...who cares if it is wasted? But typically the dose is 4 ml per session.

If you can, try to get your clinic to write the prescription so that you can use a new vial for every session, or at least every day (using the same vial for two sessions). I read that Pseudomonas can grow in saline, too.

 

[schmj4910]

We have been told to do this order: Albuterol, Hypertonic Saline, Pulmozyme. We do it all (twice a day) while doing the vest. We haven't been told to take any breaks between products. I read over the instructions we got and it did not say to wait any period of time between saline and Pulmozyme.

I use the same neb cup for the saline and the Pulmozyme. I just shake out any excess saline. I'm lazy and don't want to wash four neb cups a day. I checked with our Pulmo nurse and she said it would be ok to do this.

We use the 3% Hypertonic Saline. Ours also comes in 15 ml vials. At first, we were told to use 4 mls and keep the rest of the vial for later uses. I didn't like that idea and called the Pulmo nurse, who assured me it was ok. Mysteriously, when it was time to renew our prescription, we found that it is now written for a new vial every day! So, actually, what I do is I squirt in about 6 mls (I look at the measurements on the side of the neb cup) and then whatever is left after 15 minutes I just dump out. I like thinking that he is getting a strong, thick mist rather than sputtering at the end. And since we throw the vial out anyway...who cares if it is wasted? But typically the dose is 4 ml per session.

If you can, try to get your clinic to write the prescription so that you can use a new vial for every session, or at least every day (using the same vial for two sessions). I read that Pseudomonas can grow in saline, too.

 

[jcwise62]

Hey all:
We do the something similar to schmj4910. Up in the morning before school, that is a trail. Then a quick hit of Albuterol and a HTS full dose (15 ml) and vesting.

Sometime between 5 and 7 in the evening, when there is a free 1/2 hour, we do the same Albuterol, HTS and vest.

Around 9 p.m. we do the Pulmozyme by itself. Our Dr. wanted him to push it to as late as possible in the evening. At first it had a side effect of wiring him up, but like everyone else here. When we skip he notices and so do we.

Not sure if that is any help. We wash the neb cup after the Pulmozyme. We are really bad about not doing it after each of the HTS doses.

Jeff Wise
Dad of Parker Age 12, Dx 10.

 

[jcwise62]

Hey all:
We do the something similar to schmj4910. Up in the morning before school, that is a trail. Then a quick hit of Albuterol and a HTS full dose (15 ml) and vesting.

Sometime between 5 and 7 in the evening, when there is a free 1/2 hour, we do the same Albuterol, HTS and vest.

Around 9 p.m. we do the Pulmozyme by itself. Our Dr. wanted him to push it to as late as possible in the evening. At first it had a side effect of wiring him up, but like everyone else here. When we skip he notices and so do we.

Not sure if that is any help. We wash the neb cup after the Pulmozyme. We are really bad about not doing it after each of the HTS doses.

Jeff Wise
Dad of Parker Age 12, Dx 10.

 

[jcwise62]

Hey all:
We do the something similar to schmj4910. Up in the morning before school, that is a trail. Then a quick hit of Albuterol and a HTS full dose (15 ml) and vesting.

Sometime between 5 and 7 in the evening, when there is a free 1/2 hour, we do the same Albuterol, HTS and vest.

Around 9 p.m. we do the Pulmozyme by itself. Our Dr. wanted him to push it to as late as possible in the evening. At first it had a side effect of wiring him up, but like everyone else here. When we skip he notices and so do we.

Not sure if that is any help. We wash the neb cup after the Pulmozyme. We are really bad about not doing it after each of the HTS doses.

Jeff Wise
Dad of Parker Age 12, Dx 10.

 

[hmw]

According to the full prescribing information, at the very least it would not be a good idea to use a neb cup previously used for another medication when starting Pulmozyme.

http://www.gene.com/gene/products/information/opportunistic/pulmozyme/pi.pdf ...note the bottom of page 5, where it states that mixing could lead to adverse changes in the Pulmozyme or the mixed compound (an unwashed cup is going to contain a small amount of the previous med used in it.)

 

[hmw]

According to the full prescribing information, at the very least it would not be a good idea to use a neb cup previously used for another medication when starting Pulmozyme.

http://www.gene.com/gene/products/information/opportunistic/pulmozyme/pi.pdf ...note the bottom of page 5, where it states that mixing could lead to adverse changes in the Pulmozyme or the mixed compound (an unwashed cup is going to contain a small amount of the previous med used in it.)

 

[hmw]

According to the full prescribing information, at the very least it would not be a good idea to use a neb cup previously used for another medication when starting Pulmozyme.

http://www.gene.com/gene/products/information/opportunistic/pulmozyme/pi.pdf ...note the bottom of page 5, where it states that mixing could lead to adverse changes in the Pulmozyme or the mixed compound (an unwashed cup is going to contain a small amount of the previous med used in it.)

 

[kitomd21]

Thanks everyone. DD's CF nurse was confused about the 15mL vials and is going to contact the pharmacy to see why 15mL vials were sent instead of 4mL. I assumed give her 5-6mL for ten mins and discard the rest. Guess it does make the most sense to do Pulmozyme at night...just trying to figure out how to space the two!