Hey,
Airway clearance is our biggest nemesis. I am not sure of what all you are doing but I would recommend to you the same that I do myself, throw everything but the kitchen sink at it.
1. External CPT, tried and true, it has and always will be step one in airway clearance. Everyone has a preference how this is done, the following is my opinion. The Vest and Manaul CPT are comparable but both are better than a percussor. I do think proper positioning is important and that it really helps if you let the lobes "drain" in those positions.
2. Interal CPT- flutter or acopella, they are the same in efficacy-some use either external or internal CPT. I use both, the more the better!
3. Bronchodilation, everyone has thier opinion on this one as well, I take it all...I have recently switched to xopenex over albuterol. Recent studies show that is "better" than albuterol. I also take Spiriva and Floridil.
3. Reduce airway inflammation-I take Qvar(inhaled steroid) and Motrin. I know the studies show that it really only helps in kids but trust me, it works. I take 800mg three times a day and have for 5 years or so. Prednisone would come in here to, just not my drug of choice.
4. Thin secretions- I take Pulmozyme but am really considering adding hypertonic saline. My pulmonologist mentioned it I just haven't tried it yet. Also, it will help if you stay well hydrated. Take in your 8 glasses of water a day, that sounds like alot, but remove soda and add water and you got without even trying.
5. Finally, exercise...Exercise to your tolerance level, do not over exert yourself. The varying tidal volumes exercise causes really gets the mucous moving and makes it easier to get it out.
6. I do take Tobi every other month as well. I guess it does effect the amount of secretions but I don't consider it part of my airway clearance regimen
hope this answers your question, I may have overlooked something but I gotta run to the gym myself...good luck.
Luke