Timing of Inhaled Medications

All new inhaled medications prescribed to an individual should be trialed in the presence of an appropriately qualified health professional.

General Principles

• Individuals may be prescribed lots of inhaled medications and it is important for these medications to be given/taken in an order that provides the most benefit.
• The timing of inhaled therapies should help maximise the benefit of each medication properties whilst accommodating for the individual’s life demands.
• If the timing can be tailored to the individual, it gives them the best chance of fitting all their therapies into their day.
• Medications should not be mixed in the same nebuliser chamber and delivered at the same time, to save time.

Bronchodilator  

Protect and prepare the airways

Protect: The bronchodilator makes the airways less ‘reactive’. Bronchodilators are useful for some people to take prior to inhaling other medications which are known to irritate or cause tightening in the airways.

Prepare: Help open up the airways which help with subsequent inhaled medications entering the airways more easily.

Hypertonic Saline

• Hypertonic saline is generally inhaled before or during airway clearance techniques. Individuals may show a preference to one of these options.
• Hypertonic saline is usually delivered as either 6% or 3% depending on tolerability in the airways.
• It may be recommended you use a bronchodilator before using hypertonic saline, talk to your CF team further about this if you are unsure 

Bronchitol

• It is recommended that Bronchitol is inhaled before airway clearance techniques.
• It may be recommended you use a bronchodilator before using bronchitol, talk to your CF team further about this if you are unsure

Pulmozyme®  

• Pulmozyme® is recommended to be taken 30 minutes prior to airway clearance or after airway clearance. It is usually taken daily.
• Pulmozyme® can be also be safely taken at night just prior to bed to allow a full night to be effective on the sputum with airway clearance being completed in the morning.
• Finding a time to complete Pulmozyme® that fits in with day to day life is important to maximise how often the medication is taken.

Antibiotics

• Inhaled antibiotics are encouraged to be taken after bronchodilator therapy, hypertonic saline/bronchitol and airway clearance.

Each individual should consult with their CF physiotherapist about the ideal timing of when to take their inhaled medications based on the principles above.