Order of inhaled respiratory medicines (1037)

Key points below

Breathing treatments keep your lungs healthy.  It is good to know what your medicines do so you understand why you take them.  They work best if you take them in the right order.  If there is a medicine on this list that you do not take, skip that step.  If you take an inhaled medicine that is not on the list, ask your healthcare provider where it goes in the order.   

Take medicine in this order:

1. Fast acting Bronchodilators (such as Albuterol, Xopenex®, Combivent®, or Atrovent®)                                                          
These medicines relax the airways. Always take this before the hypertonic saline. 

2. Hypertonic saline
Saline is salty.  It will bring more water into the airways. This helps to thin the mucus so it is easier to cough out. Do not mix 7% hypertonic saline with other medicines in your nebulizer cup.

3. Pulmozyme® (DNase) or Mucomyst®
These medicines also help to thin the mucus in the lungs.  Always use a separate nebulizer kit for this medicine.

4. Airway clearance and huff cough
Now it is time to clear the airway. This is called bronchial hygiene. You may use the vest, Acapella, PEP, CPT, breathing exercises or other devices. These treatments will help move the mucus out of the airways.  It is good to huff cough during and after your airway clearance therapy to get the mucus out of your lungs.  The mucus in the lungs may be full of germs. Getting as much of it out as soon as possible is very important.  

Note:  You can do Steps 1, 2, or 3 at the same time you are on the vest.  

5. Inhaled antibiotics (such as TOBI®, Colistin®, or Cayston®)
Now that the lungs are clear after airway clearance, it is time for the inhaled            antibiotic. This helps kill the germs left in the lungs after airway clearance.

6. Inhaled steroids (such as Flovent®, Advair®, QVAR®, Pulmicort®, Symbicort®, Dulera®, Asmanex® or Alvesco®)                                      
Airways can get swollen from infection, irritation or allergy.  An inhaled steroid will help reduce this swelling.  Take this medicine last so it gets to the lungs when they are the most clear.


Call your child’s doctor, nurse, or respiratory therapist if you have any questions or concerns or if your child has special health care needs that were not covered by this information.