- In what order should I take my inhaled meds?
Bronchodilators first (e.g.salbutamol), to open up the airways.
Mucolytics second (hypertonic saline or pulmozyme), to loosen/thin secretions
Wait 30 minute (if possible)
Do airway clearance next.
Steroids (e.g Pulmicort)
Antibiotics (Tobi, Cayston, colimycin etc.)
- Which nebulizer for which medication?
Salbutamol and hypertonic saline can be taken with any nebulizer you like, even one with a mask. Antibiotics should usually be nebulized with the Pari LC Plus. Pulmozyme should be taken with the Pari LC Star. Antibiotics and pulmozyme should be taken using a mouthpiece unless otherwise directed by your physician.
- Why do my nebs take so long?
Usually, this is related to the equipment you’re using. If you’re using the right nebulizer, and your compressor is running well, most meds shouldn’t take more than 15 minutes to run through, and some take much less than that. If things are taking much longer, it may be because your nebulizer needs to be replaced, or the compressor filter might be clogged, or there may be a problem with the compressor itself. If you are doubling up meds (like mixing hypertonic saline and ventolin), it may be that there is just too much volume in the nebulizer. Also, most meds don’t need to be run until the nebulizer is bone dry. Having a few drops leftover (up to 1 mL in the case of Tobi) is okay.
- Where can I get an eFlow?
Finally, this device is available in Canada! The eFlow Rapid is available through the website http://www.agecomfort.com. Go to the search field and enter "eRapid" for information about ordering this item or replacement parts for it if you already have one.
- Won’t exercise cause me to lose weight?
- Usually, this is not a worry in CF. If anything, exercise can help you maintain or increase your lean tissue mass (i.e. muscle). If you like to exercise a lot, you should make sure that you eat within 30 minutes of finishing your workout to help your body recover properly. If you tend to have trouble maintaining your weight, make sure your post-exercise snack is fairly calorie-dense and contains protein, carbohydrate and fat. Chocolate milk or soy milk is an easy solution, especially as you will need fluids after exercise as well. Boost or other nutritional supplements are useful in this context, too. If you have more time to think about it and prepare your post-exercise snacks ahead of time, real food is always the best choice. Sandwiches are a convenient and versatile option. (Don’t forget your enzymes! If you are diabetic, check your blood sugars before and after exercise and be sure to include some carbohydrate in your snack. Always take your insulin as directed by your endocrinologist.)
- Can I exercise instead of doing an airway clearance technique?
- At this time, there is no evidence to support this approach. Most studies have shown that exercise on its own is inferior to the combination of exercise plus an airway clearance technique in terms of secretion clearance. You should do both.
- What is the best exercise program for a CFer?
- Ultimately, the best exercise for you is the one you enjoy the most and can do regularly throughout the year. Cross-country skiing is fantastic exercise, but it doesn’t do you any good in August. Having a number of activities to choose from, so you can exercise regardless of the weather or the season, is the best approach. Weight-bearing exercise is recommended for maintaining bone health. Non-weight-bearing exercises such as swimming, cycling and rowing can be a valuable part of an exercise program, but shouldn’t make up the program in its entirety. Alternating these exercises with brisk walking or running can be helpful. And don’t forget that you should be doing some sort of strength training exercise on 2 or more days per week!
- How can I find out how fit I am?
- The best and most accurate way to do this is to have a cardiopulmonary exercise test (CPX or CPET). These can be arranged through the CF Clinic. The test will involve riding a stationary bike while hooked up to machines that measure your heart rate, blood pressure, oxygen consumption and carbon dioxide production. The test starts easy and slowly gets harder until you are exercising as hard as you possibly can. This usually takes less than 10 minutes, so while it is hard, it doesn’t last too long! The results will tell us exactly how efficiently your body is working compared with the average for people your height, weight, age, gender and race. It can also help the clinic physiotherapist or an exercise physiologist design an exercise program that will help you improve your fitness by making sure the intensity of the exercise is appropriately challenging for you.