Emily does Pulmozyme three times a week and has for...a long time...I don't remember when we started. It wasn't until after she first cultured psuedo...so probably 3 or 4 months. Three times a week has, according to our pulmo, been proven to be just as effective as daily...our clinid has most of its peds patients on it. Her x-rays have looked much better since starting it. We will start hypertonic saline soon, I"m not sure if it will be a replacement or an addition to Pulmozyme. Thanks for being the advocate for your nephew. I wish our family was as involved!