In terms of medicine prescriptions, our study found that as the rate of hospitalization increased, the medication used to treat COPD and asthma risen by 2.6% each year on average. A previous study found that the ratio of salbutamol to inhaled corticosteroids prescription increased gradually in England from 2013 to 2017 as the ratio rose from 0.65 to 0.69 []. It is remarkable to demonstrate that type of medication changed over time, and national and international guidelines have also changed.
The study has many limitations. First, it is challenging to individualize the results because ecological studies base their findings on population averages. Second, this was an ecological study on the population level not on individual level, which restricted our ability to retrieve data related to comorbidities, medications history and adherence, and laboratory history, that might also influence patient outcomes.