Why am I having such a hard time controlling my asthma?

Patient: I’ve been working with my allergist for years to try to sort out my asthma, and before that with my GP, but nothing works. At first he said to stay away from my triggers and use ventolin as needed, and at first it worked, but over the last two years I’ve developed several new triggers that can’t be as easily avoided, so we scrapped that idea. Now I’m taking ventolin as needed, montelukast sodium tablets daily, and advair twice a day. But I’m still going through at LEAST 2-3 ventolin inhalers a month, when I should be using up only one. Sometimes the pharmacist refuses to fill them for me because I’ve gone through them so quickly. What should I do? My inhaler helps in the moment, but my symptoms always come back within 1-2 hours or so, sometimes sooner if it’s really bad that day. The other medication doesn’t seem to help at all.

Symptoms: Coughing, chest tightness, wheezing, increased phlegm, itchy lungs, difficulty breathing

Doctor: