My understanding is the albuterol is no longer recommended as a maintenance
medication for asthmatics. When taken without steroids to reduce
inflammation, bronchodilators (including salmeterol) tend to merely mask the
symptoms. If your son is taking 2-3 puffs per day on a regular basis to
control his symptoms, he may be headed for a severe, even life-threatening
attack.

I speak from experience. I used was using albuterol symptomatically 3-5
times per week, taking salmeterol occasionally when my symptoms seemed worse
than usual, until last July, when I had a severe attack in the wee hours of
the morning. By the time I arrived at the hospital, I was in full cardiac
arrest. Needless to say, I do not recommend this.

I am now taking Advair, which is a combination of Flovent (steroid to reduce
inflammation) and salmeterol. Since leaving the hospital in July, I have
used albuterol perhaps 3-5 times total.

These days, if you use salmeterol at all, it is strongly recommended that
you also take a steroid to control inflammation. The risks you've noted
associated with salmeterol tend to occur in patients who are not taking
steroids. This is because the salmeterol is covering up worsening
inflammation of the lungs by dilating them and because the build-up of
bronchodilators in the system tends to reduce the effectivement of albuterol
when an attack occurs.

Given my experience, I would strongly discourage continuing with the
ventolin-only approach, would strongly discourage a salmeterol-only
approach, and would strongly recommend either inhaled steroids alone for
maintenance with ventolin for symptomatic treatment only or a combination of
inhaled steroid and salmeterol for maintenance with ventolin as a back-up.
The last two options are generally considered state-of-the-art for asthma
management, depending on the severity of the patient's symptoms.