Worsening asthma symptoms despite regular inhaler use warrant a reassessment of your current therapy. Long-term methotrexate use can occasionally lead to pulmonary (lung) toxicity, which may contribute to breathing difficulty. You should consult a pulmonologist promptly to evaluate for possible methotrexate-induced lung toxicity or worsening asthma. Pulmonary function tests (PFTs) and a chest X-ray or HRCT scan may be recommended. Based on the findings, your doctor may modify or discontinue methotrexate and adjust your asthma treatment plan accordingly.

A persistent dry cough lasting several months may be due to allergic or seasonal asthma or environmental irritants. It is advisable to undergo a pulmonary function test (PFT) to rule out asthma or other airway disorders. If asthma is confirmed, your doctor may prescribe inhaled corticosteroids or bronchodilators to help control symptoms. Maintaining good hydration and avoiding exposure to allergens, dust, or smoke can also help reduce coughing episodes. If symptoms persist, consult a respiratory specialist for further evaluation and appropriate management.