Low Oxygen Levels: Causes and Management in Respiratory Health

Q: Low Oxygen Levels: Causes and Management in Respiratory Health

Dear EVAN：<br>1. <br>Continuous KP infection is quite unusual, as clinically there should be symptoms such as fever, productive cough, and abnormal white blood cell counts. <br>Please confirm with the hospital whether bronchiectasis has been diagnosed, and if so, consider using p

Hypoxemia

Hello doctor, around October last year, I started coughing up yellow sputum in the mornings.
I went to the hospital, and the sputum test indicated a Klebsiella pneumoniae (KP) infection.
I took Cravit for several weeks, but there was no improvement.
In December, a low-dose CT scan showed bronchiectasis combined with a lower respiratory tract infection, but my white blood cell count was normal.
In early February this year, I tested my sputum again, and there was still a KP infection, with normal white blood cell counts.
After taking Cravit for several more weeks, I continued to have yellow sputum, and my wheezing symptoms became increasingly severe, especially in the past few days, which felt noticeably worse.
I went to the emergency room yesterday, and the blood test results were as follows: Hb 16.6, HCT 48.2, WBC 9.31, Basophil 0.4, Neutrophil 67.2, Eosinophil 2.8, IG% 0.5, PLT 314, MCV 92.5, MCHC 34.4, MCH 31.9, Monocyte 6.3, Lymphocyte 23.3, RBC 5.21, Troponin I 3, CK 129, K 3.9, Na 139, Creatinine 1.0, GLU(ER) 100, AST 25, VBGA ctO2(a) 19.0, VBGA ctCO2 26.4, VBGA PvO2 44.6, VBGA PvCO2 38.7, VBGA PH 7.431, VBGA so2 80.1, VBGA HCO3 25.2, VBGA BE(ecf) 0.9, VBGA BE(B) 1.0, VBGA HCO3-std 24.9.
The emergency physician said that the blood test results, ECG, and X-ray were all normal.
Later, I researched and found that an oxygen saturation (so2) of 80.1 seems low? About two years ago, it was 95.2, and PvO2 was 76.1, but these numbers have been steadily declining over the past two years.
Additionally, I have had asthma for about 14 years; I started coughing up clear sputum in 2013, and in 2018, I began experiencing wheezing with activity.
I have been using a bronchodilator for maintenance but often forget to use it.
The last pulmonary function test was: 12/2020 FEV1/FVC: 77%, FEV1: 106%, TLC: 105%.
In May 2021, I tested IgE at approximately 1600.
I saw a cardiologist who said I have high blood pressure, but my heart size is normal, and my left ventricular ejection fraction is also normal.
I would like to ask if this blood oxygen level is normal? Is there a way to improve it? Also, has my asthma progressed to COPD? I did not have asthma as a child, and I have never smoked.
My family members smoke, but I have moved out of my home for over ten years.
Additionally, I am quite lazy about cleaning, so there is a bit of dust in my room, which seems to have initially triggered my asthma.

Evan, 30~39 year old female. Ask Date: 2022/03/10

Dr. Huang Yiwen reply Pulmonology

Dear EVAN:
1.
Continuous KP infection is quite unusual, as clinically there should be symptoms such as fever, productive cough, and abnormal white blood cell counts.
Please confirm with the hospital whether bronchiectasis has been diagnosed, and if so, consider using postural drainage for maintenance (you can refer to Google images for guidance).
2.
An IgE level as high as 1600 likely indicates asthma.
In Taiwan, dust mites are still the most common allergen, which is very important to note.
Persistent episodes can indeed lead to obstructive airway diseases.
3.
Blood oxygen levels and lung function are still good.
Swimming can be beneficial, and please let Changhua Hospital know that we care about you.

Reply Date: 2022/03/10

More Info

Low oxygen levels, or hypoxemia, can significantly impact respiratory health, particularly in individuals with underlying conditions such as bronchiectasis and asthma. In your case, the persistent Klebsiella pneumoniae (KP) infection and the diagnosis of bronchiectasis are critical factors that contribute to your respiratory symptoms and low oxygen saturation levels.

Understanding Your Condition
1. Bronchiectasis: This condition involves the abnormal and permanent dilation of the bronchi, leading to chronic cough, sputum production, and recurrent respiratory infections. The presence of KP infection indicates that your airways are likely compromised, making it difficult for your body to clear mucus and pathogens effectively. This can lead to further lung damage and reduced oxygen exchange.

2. Asthma: Your history of asthma, particularly with symptoms worsening over the years, suggests that your airways may be hyperresponsive and inflamed. Asthma can lead to airway obstruction, which can further exacerbate hypoxemia, especially during exacerbations.

3. Low Oxygen Saturation (SpO2): An SpO2 level of 80.1% is indeed concerning. Normal oxygen saturation levels typically range from 95% to 100%. Levels below 90% indicate hypoxemia, which can lead to various complications, including increased heart rate, confusion, and in severe cases, organ dysfunction.

Causes of Low Oxygen Levels
Several factors can contribute to low oxygen levels in your case:
- Chronic Infection: Persistent infections can lead to inflammation and obstruction in the airways, reducing the efficiency of gas exchange in the lungs.

- Airway Obstruction: Both bronchiectasis and asthma can cause narrowing of the airways, leading to difficulty in breathing and reduced oxygen intake.

- Environmental Factors: Exposure to dust and allergens in your living environment can trigger asthma symptoms and exacerbate bronchial inflammation, further contributing to hypoxemia.

Management and Treatment Options
1. Antibiotic Therapy: Since you have been experiencing a recurrent KP infection, it is crucial to consult with your healthcare provider about the effectiveness of your current antibiotic regimen. Sometimes, a different antibiotic or a longer course may be necessary to fully eradicate the infection.

2. Bronchodilators and Inhaled Corticosteroids: These medications are essential for managing asthma and bronchiectasis. They help to open the airways and reduce inflammation, improving airflow and oxygenation. Regular use of these medications is vital, and adherence to the prescribed regimen can significantly improve your symptoms.

3. Pulmonary Rehabilitation: Engaging in a pulmonary rehabilitation program can help improve your lung function and overall quality of life. This program typically includes exercise training, nutritional advice, and education on managing your condition.

4. Oxygen Therapy: Given your low oxygen saturation levels, supplemental oxygen may be necessary to maintain adequate oxygen levels in your blood. This can be particularly important during physical activity or when you experience increased shortness of breath.

5. Environmental Control: Reducing exposure to dust and allergens in your home is crucial. Regular cleaning, using air purifiers, and avoiding smoking or secondhand smoke can help manage your asthma symptoms.

6. Regular Monitoring: Regular follow-ups with your healthcare provider are essential to monitor your lung function and adjust your treatment plan as needed. This may include periodic spirometry tests to assess your lung capacity and function.

Conclusion
Your situation highlights the complex interplay between chronic respiratory conditions and low oxygen levels. It is essential to work closely with your healthcare team to develop a comprehensive management plan tailored to your specific needs. By addressing the underlying infections, optimizing your asthma management, and implementing lifestyle changes, you can improve your respiratory health and overall well-being. If you have further concerns or notice any worsening of symptoms, do not hesitate to seek immediate medical attention.

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