Hi, I'm new to this group but not to asthma (diagnosed 15 years ago).

When I was first diagnosed I was put on an albuterol inhaler and
Azmacort. For a year I was very sick. I was then, finally put on a
nebulizer w/albuterol, and I saw dramtic improvement. About 6 mos later
I got one of the first ultrasonic nebs, which not only delivered a more
absorbable mist, but also was small and portable.

Over the years the docs at my clinic tried different meds, including
Serevent, Flovent, Advair, Xopenex and Combivent inhalers - the current
philosophy seems to be that inhalers are preferred, I guess because you
can carry with you and thus are more compliant? Ever and always I must
return to the nebulizer, as none of the inhaler-delivered
broncho-dialators works as well as Albuterol in the nebulizer, and the
powdery steroid inhalers dry me out and I inevitably develop thrush, no
matter how much I rinse afterwards.

I felt the same shakiness, etc. when I first started using Albuterol in
the nebulizer, but I guess my body became used to it and I haven't had
that problem in years. I am now 59 years old and doing o.k.

My new doc is having me try Duoneb (Albuterol and Ipratropium) nebulizer
solution as it is supposed to be more effective than either alone, but
it tastes terrible (bitter), doesn't clear my lungs out as well as
Albuterol alone and also is messing up my gut.

I use Albuterol in a nebulizer a.m. and p.m. and if things are bad (sick
or allergens are especiallly bad) as often as needed during the day,
plus 4-8 puffs of Azmacort a.m. and p.m. I carry a Xopenex inhaler with
me as a rescue inhaler but seldom have to use it.

It's so trial and error and individual. Best of luck