My doc has also suggested pulmo twice a day is usually not warranted unless you're "end stage" or nothing else seems to be working. Don't know why, but I did ask if I should do it 2X a day and was told no.
I've never been off pulmo. in the last 10-12 years, so I don't know how I'd be without it. Personally, I feel like if something is working to help STOP your health from declining as quickly as it would without the med, the med is still working. Its often tough to know if meds are doing good or not helping at all until we stop them and a year or two down the road we decline. How do you know you would have declined as quickly had you been on that med? Its really a "shot in the dark" to know whether a med is working for you in the long run. I was always told with pulmo that you may never FEEL the results of it, but it has been proven in studies to "slow" the decline of health with every day use. Of course, if its causing problems with quality of life and SOB and such, obviously its NOT doing any good. So, I guess there's that too.
Anyway, hope you get some answers.