BackgroundInhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use.MethodsWe formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity.ResultsThe cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26).ConclusionsICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.

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We found an excess relative risk for serious infections in elderly-onset IBD patients on oral corticosteroid therapy. Those with current exposure demonstrated a higher vulnerability to infections.

Objective To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis.Design Population-based matched cohort study.Setting United States of America.Sample A total of 7114 women with appendicitis among 7 037 386 births.Methods Logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest.Main outcome measures Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis.Results There was an overall incidence of 101.1 cases of appendicitis per 100 000 births. Appendicitis was diagnosed in 35 570 nonpregnant women during the corresponding time frame.Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases.Conclusions Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy.Keywords Appendicitis, maternal outcomes, peritonitis, postoperative complications, pregnancy.Please cite this paper as: Abbasi N, Patenaude V, Abenhaim HA. Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases . BJOG 2014;121:1509-1514