Treatment Procedural Question (Pulmozyme)

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anonymous

New member
Just wondering how you guys administer Pulmozyme in regards to your other inhaled medications. I know it can't be mixed in the same nebulizer cup as other meds. But can you take your inhaled meds back to back - without changing the effectiveness of the Pulmozyme? Specifically, I was wondering if I can give my son his albuterol and pulmozyme treatments at the same time (one right after the other). The way I do it now is: albuterol + vest in the morning, Pulmozyme + vest in the afternoon, and albuterol + vest in the evening. There are some days that I only have time to do 2 treatments so I end up sacrificing 1 of the albuterol treatments. On those days, I often wonder if I could just do 2 inhalation treatments followed by the vest. But heck, Pulmozyme is so expensive (at least we have insurance, but with a 20% copay... yikes!), I don't want to waste it if the albuterol somehow makes it ineffective.

Thanks!
Jena
4yr old son with cf
1 yr old daughter no cf
 
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spicyone18

New member
I think you can do them back to back, I have always done it that way. Whenever i am in the hospital they do it one after the other so i think it is ok.
 
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anonymous

New member
<blockquote>Quote<br><hr><i>Originally posted by: <b>Anonymous</b></i><br> But can you take your inhaled meds back to back - without changing the effectiveness of the Pulmozyme? Specifically, I was wondering if I can give my son his albuterol and pulmozyme treatments at the same time (one right after the other). <hr></blockquote>


We are currently doing 4 treatments a day. The first is the albuterol, pct, then TOBI. The second is albuterol, pulmozyme, then CPT. The third is just albbuterol and CPT and the 4th is the same as the first. I believe it may actually be preferred that you do the albuterol, CPT and then the pulmozyme, but I don't think that has anything to do with the two interacting. Hope that helps....

Greg
Dad to Maddie 13 month old w/CF
 
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seasprite

New member
It's a good idea to give the albuterol just before the Pulmozyme. Albuterol is intended to open up the airways, which should allow the Pulmozyme to get deeper into the lungs.

Bambi, mom of Jordan, 16 w cf
 
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anonymous

New member
Just as you should use albuterol before Pulmozyme, you should also always use pulmozyme BEFORE any antibiotics as it too opens the lungs and then the antibiotics get deeper. You can use it in the same nebulizer cup (just not mixed) and rinse before you use the antibiotics.

The albuterol doens't make the pulmozyme ineffective, it actually helps.

Julie (wife to mark 24 w/CF)
 
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anonymous

New member
Hello

Kait does her advair in the morning with her vest and at school at noon she does her albuterol after school around 4:00 she does albuterol and vest again, then at night before bed she does her vest, tobi, advair and then pulmozyme

kaitsmom<img src="i/expressions/musicnote.gif" border="0">
 
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anonymous

New member
Are any of you doing treatments in a preventative mode? My 6mo old is not on any treatments but I have always been curious if others are on treatments that have not had a flare-up or hospitalization. Thanks! Paula
 
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anonymous

New member
We have always done albuterol and cpt twice a day as a preventative and when our girl is sick we do it four times a day. Our doctors told us the cpt wasn't that necessary at this point (she's 2 1/2) but it's good to get her used to it. On those mornings when she doesn't want her cpt, we just jump on the trampoline or in her bounce house!

Julie
(mom to Ally, w/o cf & Sophia w/cf)
 
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anonymous

New member
Hi Kaitsmom, My dr always told me to do my Tobi as the last thing in my regimine. Because they want that in your system the longest. It also says that oon the package insert from Chrion. You may want to check with your doc. Take care. Becky
 
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anonymous

New member
Kaitsmom, I am not sure if the order you wrote on your post is the order that your daughter actually does the treatments, but if so, she should be doing her pulmozyme BEFORE any treatments (although after albuterol). Pulmozyme is not an antibiotic, but it is a type of bronchodialator (meaning it opens up the lungs and clears them) and in addition, pulmozyme specifically thins the mucous secretions as well so they are easier to cough up. After pulmozyme your daughter should do the vest, as she just opened her lungs and thined the mucous and that will make the vest just that much more productive. Then, AFTER the vest come the antibiotics (TOBI, Colistin...). The reason why the antibiotics come after the vest is if one uses TOBI/colistin and then uses the vest, you are coughing up all the antibiotics that you just spent 15-30 minutes inhaling.

Jena, this might help answer your question as well.


Julie (wife to Mark 24 w/CF and RN)
 
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anonymous

New member
actually pulmozyme has no bronchodilating properties. What you want to do is this....Always take your albuterol first(beta-agonist). If you take pulmozyme take it next, after the pulmozyme, take time to cough and get any extra junk out. If you take an anti-cholenergic like atrovent (ipratropium) take it next, it does not work if it doesn’t touch the lung wall. Then finally your antibiotic of choice. The premise is to open up your lungs and clear them out as much as possible to "get" more antibiotics. If you take an inhaler (advair, pulmicort, spiriva), take it after your other neb treatments for the same reason. This is actually theoretically perfect and not the real world. Since doctors don’t live in my world I do things a little different.

I actually mix my albuterol and pulmozyme together, get done with it and fill the same cup full of tobi. Doctors tell you to use different nebulizers due to compatibility issues, not because they are not compatible, just because there has never been any studies to support it.
So I have done my own, I have been doing it for years and have no problems. Just a side note, I do not mix my cholistin, it is hard enough to handle by itself. Oh yea, in the name of time conservation my wife does my CPT while I do my treatments.



Luke RRT 29/cf
 
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cfgirl38

New member
Please dont tell people to reuse their cups without rinsing using Pulmo & Tobi. They say that because it can make you very sick. Just because you take that gamble don't offer that to others. If your going to use the same cup be sure you rinse it really well as others said with hot water.
 
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NoDayButToday

New member
Paula- I started doing aerosols when I was about 3 or 4 years old. Before that, my mom did do CPT on me. It was done as a preventative thing. I'm seeing many more little, little kids on here who do aerosols from a very young age, so I think maybe protocol has changed since I was little.

Jena- I always do my nebulizers in this order- Xoponex (equivalent to albuterol), Pulmozyme, then my antibiotic if I am on one. I do my Fluter after Pulmozyme, but before the antibiotic.

I use separate cups for all of them- Pari Cup for Xoponex and antibiotics, and a Sidestream for Pulmozyme.
 
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anonymous

New member
Becky,

I did not tell anybody to do anything, I only said what I did. As for "they", have them sight their source and reasoning. I mentioned why it is recomended not to mix meds and cups, but as far as I know there is NO evidence that it will HURT anyone.


Luke
 
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anonymous

New member
Honestly coming from someone whom seems to know info on ALL subjects I'm surprised by your statements. It states in the Pulmozyme guide you receive in your prescriptions. " Pulmozyme should not be diluted or mixed with other drugs in the nebulizer, Mixing of Pulmozyme with other drugs could lead to adverse physicochemical and or functional changes in Pulmozyme or the admixed compound. On the Tobi site it states" Do not mix Tobi with dornase affa (Pulmozyme) in the same neb. You may have not said for other to do so but you letting people know that there's no studies to support this makes you sound as if your an expert which I don't beleive you are. I'll say again to give medical info that goes entirely against a packages warnings, gambles with your life as well as others your letting know its ok. Correct? Do you honestly have to SEE a study when the people whom manufacture the product says not to. Silly....
 
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anonymous

New member
Hi Coll - Why the sidestream for the pulmozyme? Does it deliver the pulmozyme better? Just curious. I use the pari ones for alb/pulmicort, pulmozyme and TOBI. We use 3 diff. cups. We mark one with a T, one with a P and leave the other unmarked. Thanks! Jo Ann
 
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anonymous

New member
Becky,

As I said, they say that because they haven't done any trials to support it. This is the case with many drugs, until somebody spends the time and effort to "prove" compatibility they will always state that to remove liability. That is why the manufacturer states, "no formal drug interaction studies have been performed". I assure you this is very common in the medicine world. An example: For years it was not recommended to mix atrovent and intal, in hospitals it was widely done, but not recommended. Within the last 5 years someone finally put the time and effort into the research and now it is considered acceptable. But it all is just part of the SILLY scientific process!

This discussion is quite fruitless and I am really getting tired of repeating myself. Your right I do put my input into the more technical questions, but I have never claimed to be an expert on anything, only given my advise and nobody has to take it. But, for the record the initial part of my response was absolutely correct.

Thanks for your input


Luke
 
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NoDayButToday

New member
<blockquote>Quote<br><hr>Why the sidestream for the pulmozyme? Does it deliver the pulmozyme better? Just curious. I use the pari ones for alb/pulmicort, pulmozyme and TOBI. We use 3 diff. cups. We mark one with a T, one with a P and leave the other unmarked. Thanks! Jo Ann <hr></blockquote>

The Sidestream is more time efficient, so I use it for time saving. I only use it with Pulmozyme, because, as its name kind of implies, it lets off a lot of the med off. So, you can't really use it with albuterol/xoponex/antibiotics etc. because they have specific doses. But you don't need a specific amount of pulmozyme to be effective-- so I guess basically, I use it to save time, but only where applicable.
 
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