Cerivastatin and Reports of Fatal Rhabdomyolysis

Abstract

Comparisons between patients with mild asthma and those with persistent asthma who are receiving high doses of inhaled glucocorticoids must include a careful evaluation of base-line characteristics.2 Table 2 of the article shows that the 28 women who did not use inhaled glucocorticoids weighed less than the 42 women who required more than eight puffs of inhaled glucocorticoids per day (mean [±SD], 140±20 vs. 154±40 lb), had nearly twice the level of physical activity (98±54 vs. 55±71 metabolic hours per week), had a lower incidence of past or current use of inhaled glucocorticoids (14±36 percent vs. 62±49 percent), and were less likely to have a history of oral-glucocorticoid use (36± 49 percent vs. 79±42 percent). All of these base-line differences appear to be statistically significant. It is as if we compared the bones of a busload of women soccer players with those of a busload of sedentary women.A relative lack of gravitational exercise can obviously contribute to bone loss, as shown most clearly in astronauts returning from zero gravity. Because the presence of persistent asthma limits one's ability to exercise, the resulting inactivity and other changes in variables reflecting the severity of asthma (e.g., weight, prednisone use, and airway inflammation) invalidate any reliable analysis of the effects of inhaled glucocorticoids on bone loss in groups that were so dissimilar at base line in the absence of a randomized scheme of treatment allocation.