We have similar thoughts and experiences.

I usually find that I can get by with 6-7 "breaths in" twice a day or from
10-12 "breaths in" to as much as 1 1/2 - 2 minute treatment (by the clock)
if i am needing it.  Agreed on whatever is necessary for relief and of
course that differs per individual.

My wife does at least a vial a day, often 2, and is having problems with
blood pressure, heart rate and excitability.  She takes more pills for those
(and several others) and I kid her about taking pills on top of pills for
problems created by pills (or inhalations).

The thing is, she and I have both been in the literally "stumbling" out of
breath mode, but really haven't been for over a year....and i offered the
opinion last week that now, the least discomfort sends us running (huffing
and puffing) to the nebulizer.  It is on this basis that i cannot say
whether the efficacy of racemic albuterol for us has abated.  I still have
part of a box of 60 vials that I bought last May,  I did check the
expiration date and it is August, 2006 -- they are kept in the dark, at room
temperature.

I also agree on the sinus congestion.  The best thing I found in years for
that - by accident --  was Primatene mist, inhaled and then exhaled through
the nose.  I can't say that Primatene is that great as a bronchodilator
(Beta-agonist?) What it did was relieve my congestion without the
reingorgement of the stronger Afrin-type stuff.  (Course, after several
months, I got "used" to that and Primatene did not work the sinus miracle
anymore.)

I have wondered if the MDI might not be a higher percentage dose, but have
not read the micro-print recently. :-)

For those who have not heard this:  For us people, an all-nighter has come
to mean sleeping till dawn.

(for the septic crowd, note that the ingredients in your racemic albuterol
has a tiny percentage of sulfuric acid, for Xopenex the tiny percentage is
hydrochloric acid -- or maybe the two acids are the other way around.)

jim