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Why you NEED an eFlow a.k.a. Trio and Altera

I’ve been using an eFlow nebulizer since March 2006, and it has single-handedly changed my ability to do all of the nebulized treatments that are prescribed. Like everyone else, I was raised on a pneumatic nebulizer pump. They’re loud and take forever and a day to run through 3mL of dosage, usually 20-30 minutes each, right? You have to have an outlet nearby or have a DC/AC converter for your car.

What if I told you that you can do a dose in 90 seconds to 3 minutes running on rechargeable AA batteries? It pretty much eliminates every excuse in your book about not having enough time or an outlet available. You can see by my list of meds how long 30 minutes per dose would take me every day with old technology.

My first eFlow was a first generation machine and was eventually determined to be ruining the little aerosol head that microscopically disperses the medicine into a mist much finer than any air-driven neb can. My doses were taking longer and longer, until it was taking as long as a regular neb, and I pretty much gave up on my treatments because I really didn’t have that much time. I got a new machine, now the current Trio by switching to another specialty pharmacy.

The nittly gritty on getting your hands on an eFlow

I switched to Pharmaceutical Specialties in Georgia, who lease the device for free as long as you’re prescribed certain meds. I called them yesterday to confirm which meds get you a free device: mixed tobramyacin (not TOBI, as it’s too concentrated) and colistimethate. Something to keep in mind, they don’t mix the colistine, so they send sterile water vials, the colistine powder vials, and pre-needled syringes. There are other pharmacies that pre-mix a month of colistine, but they were unwilling to swap out my eFlow for one that worked, so it’s your guess how I feel about one in particular. /grin

Here is a full list of what they offer for CF patients with overnight, A.M. delivery if you schedule shipment a couple of days ahead:

  • Preservative free unit dosed tobramycin for nebulization in eFlow ® nebulizer
  • Pulmozyme ®
  • TOBI ®
  • SourceCF Softgel High Potency Adult Multivitamins softgels, chewables, and drops
  • Hypertonic Saline 3%, 5%, 7% including Hyper Sal by PARI
  • Colistimethate
  • Xopenex ®
  • Pancreatic enzymes
  • Antibiotics
  • Many more

I’ve been told by my coordinator that they also sell Cayston (AZLI) with its own version of the eFlow, called Altera. I have both devices since I’m still on the long-term trial of AZLI while it’s still free. Note: I also receive my ZenPep from PSI.

Caring for your eFlow

This section is easy because my coordinator sent us a PDF of tips and such regarding eFlows. The only thing they would like to amend from the document is that it refers to using tap water to rinse, but they would recommend using sterile water to avoid any bugs that might be present in tap water. Here is the PDF file.

Updated post – June 2010: My Nebulizer’s “Dirty Head”


  1. It's amazing how many people still aren't using this device – it has been a huge time saver for our child.
    We only use it for Tobramycin as the HS was clogging the head no matter what we did.
    Have you tried HS in the new device?
    We picked up a Pari Trek S for when we travel (all the time) so our son can do his HS. It's really quiet and has a lithium battery. Still slow but 2 out of 3 issues with compressors handled.

  2. Thanks for stopping by.

    I use my second-newest head with hypertonic saline so my primary head
    doesn't get gunked up. Rinsing in hot water immediately helps as much as

  3. Ya, tried doing that – run to the sink, rinse under hot water, shake in hot soapy water, rinse then right into the sterilizer. Helped some but once it got up to 10 minutes, it wasn't worth doing that inbtween HS and Tobramycin. It would be great if they could design a head for HS but there's no money in it for them I guess.

  4. I really like this post. Nice job. I have found that using HTS in the eFlow does not work for me. It doesn't may save me time, but it doesn't bring up the gunk. I now have to do two vials back to back to get the stuff completely out.

  5. Sorry, typing fast. It doesn't save me time. That's what I meant to write.

  6. Thanks, man. But you use it for other meds? It's a life-changer, for sure, eh?

  7. I only use it for antibiotics. I find the Invacare Mobilaire to be easier and just as effective with xopenex, HTS and pulmozyme, but without the head cleaning issues of the eFlow. Don't get me wrong, I love the eFlow. But I only like one med per head. 🙂

  8. PSI gives you one head per med. 😉 I like them so much more than my first
    eFlow experience.

  9. PSYCHED TO KNOW ABOUT THIS! Right now I have to allocate an extra hour to do all my nebulizers…this could change my life and let me sleep! I’m going to email my CF team right now about this. THANK YOU FATBOY! Please pardon the caps, I am psyched to learn that I could stop skipping drugs in the name of sleep.

    • As long as you are on Cayston or Colistin, you shouldn’t have a problem getting it for free on lease. If you need to, you can buy it. The Zenpep rewards program also allows you to rent the device as a reward for using Zenpep, but then that is pretty much your only reward available from them if my points memory serves me right.

      • Hi Jesse,

        Hmm, I am not on these medications. My current regimen is albuterol, HTS, pulmozyme, TOBI. Sounds like I need to do some more research instead of jumping up and down excitedly.


        •  Jenn,
          Call PSI and talk to them. My daughter is on pretty much the same meds as you and they still lease it to us for free. They’re also really good about sending replacement parts or even a new machine.

  10. Susanpollis says

    I’m writing from the UK. Parent of child with CF.
    Pari recommends using the Easycare eFlow cleaning aid when nebs start taking longer. It’s a simple, plastic ‘backwash’ device, that forces solution back through the mesh head to dislodge sediment.
    Do you use one?

  11. i bet this is a huge time saver! i have cf myself and i know what a pain in the butt it is to lug everything around and to have to take time out of your day to do your treatments. hopefully there will be a cure soon so we no longer have to do our breathing treatments.