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Physiotherapy and inhalation with asthma and CF

[Note: below are two similar questions asked by the same person – the answer refers to both of them.]

Physiotherapy with asthma and CF

In the morning, I (female, 43 years old) first inhale Symbicort® (budesonide and formoterol) to open up, then Spiriva® (tiotropium bromide), then Pulmozyme® (dornase alfa) and after 1-2 hours NaCl with 4 drops of Ventolin® (salbutamol). After that, I do PEP (with smallest opening) and white rib belt, and then autogenic drainage in lying position in order to cough up. Altogether, this takes one hour, but I can nevertheless loosen up the secretion only partially and have to do therapy again around noon. This is quite a burden on my daily routine. Perhaps you have an idea what I could do/inhale differently in order to be able to cough up better. I have a lot of sputum and do not tolerate the antibiotics for inhalation, but I rarely have infections.

Many thanks and kind regards.


Inhalation with asthma and CF


due to severe allergic asthma with CF, I (female, 43 years old) inhale two puffs of Symbicort® (budesonide and formoterol) (6) Turbuhaler three times a day, Spiriva® (tiotropium bromide), and Pulmozyme® (dornase alfa) in the mornings (after Symbicort®). I do not tolerate antibiotics. Before drainage, I additionally inhale NaCl 0.9% with 4 drops of Ventolin® (salbutamol), all of this with the E-flow. I can nevertheless loosen up the secretion only partially in the mornings and have to do therapy again around noon. This is quite a burden on my daily routine. Do you see an option (perhaps inhaling the Ventolin® first in the morning, or a higher dosage; or using a different spray) whereby I would only have to do drainage in the morning and evening?

Many thanks.
Dear questioner,

Many thanks for your question about inhalation. It is important that you have information on the effects of the individual inhalations, since this is the only way to optimize your personal inhalation and physiotherapy. If you are being treated by a competent physiotherapist, you should adjust the daily inhalation and physiotherapy with her.

The amount of time you spend on inhalation and physiotherapy seems quite high to me indeed. I would thus recommend you combine the physiotherapy with the inhalation therapy: autogenic drainage with the classic humid inhalation (I would prefer compressor inhalation here, E-flow is too fast) and the PEP system lends itself to opening up the bronchia and mobilizing the secretion. Hole size 2-2.5 is probably easier for you. The belt can be used in addition. I would use Spiriva® and Symbicort® only afterwards (when the bronchia are cleaned).

Good luck!
Kathrin Könecke