(note: the ramblings below do not indicate any kind of medical qualifications whatsoever, I’m just a fellow wheezer who reads obsessively).
I had to look up Seretide - thought at first it was just Serevent (salmeterol) but I see it’s the same combination as Advair, just a different name. It’s fluticasone which is a steroid, and salmeterol which is a long-acting bronchodilator.
250/50 is not a high dose, especially if he’s just taking 2 puffs a day. I was on Flovent (fluticasone only) for a long time, and my dosage was a 220 microgram inhaler, 2 puffs twice a day (so 880 mcg). Seretide seems to be available in a 500/50 combination (500 mcg of fluticasone). Taking that twice a day would be comparable to what I was taking .
There are differences in the amount absorbed in the different inhaler types (dry versus aerosol); I don’t know if Seretide is a dry powder inhaler or an aerosol inhaler.
From some recent reading I’ve been doing - and assuming I’ve interpreted it correctly! - dry powder may give better availability of the medication versus an aerosol (because of larger aerosol particles getting stuck in the throat, poor timing of the aerosol etc.) but dry powder of course depends on your being able to breathe in with enough force.
How often is he using the salbutamol (for us Yanks, that’s albuterol e.g. Ventolin, Pro-Air etc.)? If it’s more than a couple times a week that’s an official sign that his asthma is inadequately controlled.
What kind of response does he get when he takes it? Does he feel better? Is he using a peak flow meter? That can be a very good way to track his response, and I’ve heard it can help alert people to worsening asthma even before they feel bad (not so for me, I’ve never had a bad reading that I couldn’t have told you about before I blew into the tube).
The impression I get from doing all the reading lately is that of the long-acting beta agonists (salmeterol a.k.a. Serevent, and formoterol a.k.a. foradil) is that formoterol is slightly preferred from a safety/efficacy standpoint, though I don’t think there’s a strong argument for a switch if one is working OK. Of course, the dual-medication inhalers with formoterol, Symbocort and Dulera, use a slightly less potent steroid (budesonide or mometasone) so there’s a tradeoff there.
I would strongly urge you to get his sorry ass to the doctor for a thorough workup. His medication may be inappropriate, or not the right dose.
There are other things to try as well - for example a brief course of oral steroids, adding a leukotriene inhibitor such as Singulair (a once-daily pill), a garden-variety antihistamine, or even the dinosaur of asthma control, theophylline! That one’s fun - I’ve been on it for over 25 years, and all efforts to quit it have failed (I forgot to take it a couple of mornings recently and my lungs told me I’d done a stoopid thing).
It’s also possible that there are other things going on that mimic asthma - this is something I’m personally looking into for myself right now (e.g. reflux, sinus issues, apnea) where all the asthma meds in the world won’t help much. The pulmonologist told me that with these mimics, you may feel a little better with a puff of the rescue inhaler (salbutamol/albuterol) but your breathing tests won’t show that improvement.
Certainly it’s worth taking steps to control the allergens. I don’t know that taking the mattress out into the sunlight would make that big a difference, because the mites can live in side the mattress. The evidence for mattress covers may be weak but it couldn’t hurt (except the pocketbook) to give it a try. Replacing pillows is also a cheap and easy thing to try. Doctors used to be quite draconian and demand that you remove anything remotely soft from the bedroom (rugs, drapes, teddy bears etc.) but I think they’ve backed off on that!!
