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Updated: May 6, 2026
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Asthma and hemoglobinopathy: when is supplemental oxygen required?
Leon Joseph1, Inbal Brickner-Braun, Berry Pinshow
1Pediatric Pulmonary Unit, Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Midreshet Ben-Gurion, Israel.
Summary
Persistent low oxygen saturation in a child after asthma recovery was due to abnormal hemoglobin. Plotting the oxygen dissociation curve determined when supplemental oxygen was truly needed for this specific hemoglobinopathy.
Area of Science:
- Pediatric Pulmonology
- Hematology
- Clinical Biochemistry
Background:
- Asthma is a common childhood emergency department diagnosis.
- Supplemental oxygen is typically administered when oxygen saturation is below 90% during severe asthma attacks.
Observation:
- A child exhibited persistent low oxygen saturation (SpO2) post-asthma recovery, despite normal arterial oxygen partial pressure (PaO2).
- Hemoglobin electrophoresis and genetic analysis identified an abnormal hemoglobin variant (hemoglobin Seattle) with reduced oxygen affinity.
Findings:
- The patient's SpO2 of 70% corresponded to a PaO2 of 60 mmHg on a custom-plotted oxygen dissociation curve.
- This indicates a significant shift in the oxygen dissociation curve due to the hemoglobinopathy.
Implications:
- Pulse oximetry alone may be misleading in children with specific hemoglobinopathies.
- Oxygen dissociation curve analysis is crucial for guiding supplemental oxygen therapy in such cases.
- This method aids in accurate clinical decision-making for pediatric patients with abnormal hemoglobins.
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