Coughing Up Blood (Hemoptysis)

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What is coughing up blood (hemoptysis)?

Coughing up blood is the production of blood or bloody mucus from the lower respiratory tract. This includes the lungs and bronchial tubes—the main airway passages. Hemoptysis is the coughing up blood medical term. It is different from spitting up blood from the mouth, throat or stomach.

Common causes of coughing blood include bronchitis, pneumonia, tuberculosis, and bronchiectasis (inflammation of the airways). Other causes include lung abscess, lung cancer, and PE (pulmonary embolism). Medical tests and procedures, such as bronchoscopy and respiratory tract biopsy, can lead to coughing up blood as well.

A bloody cough may appear pink and frothy when it mixes with air and mucus from the lungs. It can also be bright or rusty red. Hemoptysis may involve large amounts of blood or mucus may appear streaked with blood.

The first step in diagnosing hemoptysis is to determine if you are truly coughing up blood from the lungs. Doctors need to confirm it is actually blood while also ruling out the possibility of blood coming from the digestive tract, throat, or nasal passages.

Is coughing up blood an emergency?

Contact your doctor or seek prompt medical care if you are coughing up blood. Seek immediate medical care (call 911) if you are coughing up large amounts of blood, the bleeding won’t stop, or you have any of the following symptoms:

Contact your doctor any time you are concerned about the color, consistency or amount of liquid or mucus a cough produces.

What other symptoms might occur with coughing up blood (hemoptysis)?

You may experience other symptoms, depending on the underlying cause. These symptoms can affect other body systems, such as the circulatory system and the digestive tract.

Other symptoms that may occur along with hemoptysis

Coughing blood may occur with other symptoms including:

Serious symptoms that might indicate a life-threatening condition

In some cases, coughing up blood can occur with other symptoms that might indicate a serious or life-threatening condition that needs evaluation in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:

  • Bloody stools or urine

  • Changes in consciousness

  • Chest pain

  • Dizziness, confusion or disorientation

  • Fever

  • Lightheadedness

  • Shortness of breath or wheezing

What causes coughing up blood (hemoptysis)?

Several different respiratory diseases, disorders and conditions can cause hemoptysis, many of which are serious, life-threatening situations. However, it can be difficult to find the source of the blood in some cases. Blood that is not coming from the lungs may be spit up from the throat or nose. You can also swallow blood and regurgitate it from the stomach.

Possible causes of coughing up blood

Reasons for coughing up blood are varied. It is most commonly due to bronchitis, pneumonia, tuberculosis, and bronchiectasis (inflammation of the airways). Medical tests and procedures can also cause hemoptysis. This includes bronchoscopy and respiratory tract biopsy. Other possible causes, some of which are potentially life-threatening include:

  • Aortic aneurysm, mitral valve stenosis, and heart failure

  • Chest trauma or foreign body

  • COPD (chronic obstructive pulmonary disease) and cystic fibrosis

  • Crack cocaine use

  • Legionnaires’ disease

  • Lung abscess and lung cancer

  • Pulmonary aspiration (inhaling food or other substances into lungs), pneumonitis, and pulmonary embolism (blood clot in the lung)

  • Taking blood thinner medications

In about one-third of patients, doctors can’t identify a cause. Close monitoring is necessary to make sure lung cancer or another condition is not the cause.

Conditions that can mimic coughing up blood

Some non-cardiopulmonary medical conditions can lead to blood coming from the mouth and mimic coughing blood. These include:

When should you see a doctor for coughing up blood?

Coughing up blood may or may not indicate an urgent situation. If you notice blood in your sputum, contact your doctor to find out if you need to be seen right away. If you cannot get in contact with your doctor, seek prompt medical care.

Call 911 or go to your nearest emergency room for hemoptysis when:

  • You are constantly coughing up blood.

  • You are coughing up more than about two teaspoons of blood.

  • You have blood in your urine or stool.

  • You have other lung symptoms, such as shortness of breath, wheezing, or chest pain.

  • You have other symptoms, including confusion, disorientation, dizziness, fever, leg pain and swelling, lightheadedness, or passing out.

How is the cause of coughing up blood diagnosed?

If you are coughing up blood, your doctor will look for a treatable cause. The first step is taking a medical history and doing a physical exam. Doctors will want to know about your symptoms, chronic medical conditions, travel history, and tobacco and alcohol use.

If your doctor suspects the blood is coming from your lungs, testing is necessary to find the cause. This can include:

  • Chest X-ray to look for a mass or other lung disease

  • CT (computed tomography) scan if X-ray findings are abnormal

  • Bronchoscopy to view the inside of the lungs and confirm the source of bleeding or diagnosis, and treat the cause if possible

  • Lab tests, such as blood clotting time, complete blood counts, and urinalysis, to support and further define the diagnosis

  • Lung perfusion scan or CT angiography if pulmonary embolism or lung inflammation is possible

  • Sputum sample for culture if infection is suspected

The results of these hemoptysis tests will help your doctor design a treatment plan. Treatment will depend on the underlying cause. The goal is to stop the bleeding and treat the cause. Some treatments to stop bleeding, such as cauterizing tissue, may be performed during bronchoscopy or may require surgery. Doctors can also administer medicine directly to the area.

What are the treatments for coughing up blood?

Treating massive hemoptysis requires emergency interventions. The goals are to protect the other lung and prevent severe or catastrophic blood loss. There are various emergency treatments that can accomplish these goals.

Treating minor cases of coughing up blood depends on the underlying cause. The most common causes are related to infections or inflammation—bronchitis, pneumonia, tuberculosis and bronchiectasis. For these conditions, doctors may prescribe any of the following:

  • Antibiotics to treat bacterial infections
  • Bronchodilators to open the airways
  • Expectorants to help bring up mucus
  • Mucolytics to thin the mucus and make it easier to expel
  • NSAIDs (nonsteroidal anti-inflammatory drugs) to reduce fever and relieve pain and inflammation

Other causes of hemoptysis will require therapies specific for them. If hemoptysis persists or does not respond to treating the underlying condition, doctors may prescribe tranexamic acid (Cyklokapron, Lysteda), which improves blood clotting.

Home remedies for coughing up blood

If your doctor diagnoses a respiratory infection as the cause of hemoptysis, there are some home remedies that can help you feel better.

Self-care tips for respiratory tract infections include:

  • Avoid smoke and airway irritants: Smoke, perfume, cleaning sprays, and other irritants can trigger coughing and increase mucus production.
     
  • Cough suppressants, but ask your doctor first: Antitussive medicines suppress your cough reflex. This can be helpful if you are coughing up blood due to heavy coughing. However, they can contribute to airway blockages by keeping you from bringing up clots and mucus. Check with your doctor to see if you should use them or not.
  • Have some chicken soup: Chicken soup gives you extra fluids, but it also contains cysteine. This amino acid thins mucus. Chicken soup may also block inflammatory cells called neutrophils. 
  • Stay hydrated: Drinking extra fluids can help thin mucus so you can cough it up easier. The best choices are water, hot tea, or sports or electrolyte drinks. Try adding a teaspoon of honey to hot tea or water. It can help soothe a cough.
  • Use humidity: A steamy shower can help open and drain your airways. A humidifier will keep moisture in the air you breathe.
  • Wear layers: If you are fighting a fever, dress in layers so you can add or shed garments quickly. This will help avoid overheating and getting hot and sweaty.

What are the potential complications of coughing up blood?

The complications of an untreated or poorly controlled cough that contains blood can be serious and even life-threatening. Over time, coughing blood can lead to serious complications including:

Failing to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, follow the treatment plan your doctor recommends to reduce the risk of potential complications.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 12
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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