Inhaled Medications and Nebulizers

The Cystic Fibrosis Foundation and the Stanford CF Center staff recommend the following sequence for inhaled medications:

  • Bronchodilators (Albuterol, Combivent™, Xopenex™) to open the airways
  • Hypertonic Saline (7%) to mobilize mucus and improve airway clearance
  • Pulmozyme™ (DNAse) to thin mucus
  • *Airway Clearance Technique: Vest, Flutter™, Chest PT, IPV, etc.
  • Antibiotics (TOBI™, Colistin, Cayston). The previous therapies open and clear the airways of mucus, allowing these antibiotics to work on remaining bacteria.
  • Steroids (Flovent™, Pulmicort™, QVAR™)

* When using the Vest for airway clearance, make sure there is aerosol delivery during the entire vest session.

If you start coughing blood, temporarily stop Pulmozine™, saline, airway clearance technique, and inhaled antibiotics. Call your CF doctor or nurse for further advice.

With a respiratory illness or change in symptoms:

  • Begin or increase airway clearance techniques.
  • Use breathing treatments as ordered; you can use bronchodilators every three to four hours, and often additional Vest and/or hypertonic saline treatments are useful.
  • Contact your CF doctor or nurse to see if antibiotics or additional intervention is needed.