I do the Pulmozyme twice a day because that is what I have gotten the best results from, right from the drug study start. I am more productive and stable with it that way, and have been back to doing it twice a day (instead of once) for the last couple of years. I am checking into magnesium supplements, though, as I have read a study or 2 suggesting that low mag can lower Pulmozymes effectiveness, and the rest of my vitamins were borderline or low last time- mag wasn't checked, however... My fev1 was 47 last I checked, so a bit lower than yours <img src="i/expressions/face-icon-small-wink.gif" border="0"> .