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When Andrew Knight woke up after surgery, he had a new hip.
At just 45 years old, he was taking his first steps with a walking frame after undergoing a total hip replacement.
“I’ve been dressed better,” he jokes about the hospital gown and drain bag.
“Not my finest look, but certainly memorable.”
But behind the humour is a story he hopes will help others ask an important question before they find themselves facing the same outcome.
Oral steroids saved my life
Oral corticosteroids, such as dexamethasone, prednisone or prednisolone, are an important rescue medicine and can be lifesaving during a severe asthma flare-up.
“They carried me through severe fistulating Crohn’s disease, severe asthma and organising pneumonia,” he says.
The problem is that many people don’t realise the risks can build up over time.
The hidden impact of repeated courses
Andrew has lost count of the number of oral steroids he’s taken throughout his life.
What he didn’t know was that every course contributed to his lifetime cumulative dose.
“No one ever told me steroids keep a receipt,” he says. “Not the five-day course – the lifetime total.”
Over time, repeated exposure to oral steroids increases the risk of serious side effects. These can include osteoporosis, diabetes, cataracts, cardiovascular disease, adrenal suppression and, in some people, avascular necrosis – where reduced blood supply causes bone tissue to die.
For Andrew, that damage affected his hip.
“The femoral head weakened and collapsed,” he says. “I ended up needing a hip replacement at 45.”
Andrew’s experience is uncommon and will not happen to everyone who takes oral steroids. Oral steroids remain an important and sometimes lifesaving treatment when prescribed for severe asthma flare-ups. The benefits and risks of treatment vary from person to person. However, the risk of side effects can increase as lifetime exposure grows.
What health checks should I discuss if I have had multiple courses of oral steroids?
The number every person with asthma should know
Research suggests that a cumulative lifetime dose of around 1,000 mg of prednisolone (or equivalent) is associated with an increased risk of long-term side effects. The risk varies between individuals and depends on factors such as age, overall health and total exposure. Depending on the dose prescribed, some adults may reach this level after around four courses of oral steroids.
The challenge is that many people living with asthma have no idea how much oral steroid they’ve taken over the years.
Andrew certainly didn’t.
“I never knew my number,” he says.
“Nobody offered it. That’s the bit I want to change.”
One question that could change your future
Andrew now encourages everyone with asthma to ask a simple question at their next healthcare appointment:
“What is my cumulative oral steroid dose, and what’s the plan to reduce it?”
“It’s not about being difficult,” he says.
“It’s about being your own clinical advocate.”
This isn’t about refusing oral steroids when you need them. If you’re experiencing a severe asthma flare-up, oral steroids can be lifesaving and should be taken exactly as prescribed.
Instead, it’s about working with your healthcare professional to improve day-to-day asthma control so future flare-ups – and future oral steroid courses – become less necessary.
That might include reviewing your preventer medication, checking your inhaler technique, updating your written Asthma Action Plan or, if your asthma remains difficult to control, discussing whether a referral to a specialist is appropriate.
Understanding your cumulative lifetime exposure doesn’t mean avoiding treatment when you need it. It means making informed decisions, having conversations with your healthcare team and reducing future reliance on oral steroids wherever possible.
If you’ve had more than a few courses of oral steroids for asthma, it could be time to review your asthma management.
Visit Asthma Australia’s Smarter Oral Steroids hub to learn more about cumulative oral steroid exposure, check whether your asthma is well controlled and find practical steps to reduce your risk of future flare-ups.
