Hemoptysis (Coughing Up Blood): Causes and Treatment

Coughing up blood (hemoptysis) can be a concerning and painful symptom.

There are many possible causes of hemoptysis, some of which are serious and can be life-threatening.

If you’re coughing up blood, it’s important to reach out to your medical provider as soon as possible to identify the underlying cause and treatment options. 

In this article, I’ll cover some of the most common causes of hemoptysis, how they’re diagnosed, and what treatment options are available.

Keep in mind that the only way to confirm the cause of your hemoptysis is to speak with a medical provider. 

What is Hemoptysis?

Hemoptysis is the expectoration of blood from the lower respiratory tract (including the lungs, bronchi and bronchioles, and air sacs), sometimes mixed with mucus.

It’s important to distinguish this condition from pseudohemoptysis, where the blood originates from the upper gastrointestinal tract or upper respiratory tract (including the mouth, nose, and throat). 

The majority of hemoptysis cases occur in adults, and men are affected twice as often as women.

It can be a symptom of several diseases and infections, but the cause remains unknown in about half of all cases.

Causes of Hemoptysis

There are many possible causes of hemoptysis, though some of the more recognized causes are infectious and inflammatory airway diseases.

Blood clot in the lung

Hemoptysis can be a symptom of blood clots in the lung.

In these cases, you’re more likely to cough up clots or bright red blood than bloody mucus or foul-smelling mucus.

Blood clots can be a symptom of several conditions, including:

• Pulmonary embolism
• Lung cancer
• Tuberculosis

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) refers to a group of chronic diseases that cause breathing-related problems, including chronic bronchitis and emphysema.

Both are progressive lung diseases that get worse over time.

Symptoms of COPD include:

• Shortness of breath (especially during physical activity)
• Chronic coughing fits
• Chest tightness
• Regular respiratory tract infections
• Lack of energy
• Swelling in the legs and arms
• Coughing up blood and/or mucus

The most common cause of COPD is smoking, but other major causes include:

• Exposure to secondhand smoke
• Long-term exposure to chemicals or irritants
• Other environmental factors, like working or living in places of high-pollution or certain gasses and fumes or around a source of heat that isn’t well ventilated 

Though there is no cure for COPD, medication and lifestyle changes can help to delay its progression. 

Cystic fibrosis

Cystic fibrosis is a genetic disorder that affects roughly 35,000 people in the United States.

People with cystic fibrosis have blocked airways caused by mucus that is thick and sticky.

This mucus also traps germs (which can lead to a higher rate of infection) and prevents proteins from reaching the intestines, making it difficult for the body to properly absorb nutrients from food.

Signs of cystic fibrosis include:

• Salty-tasting skin
• A cough that doesn’t go away 
• Coughing up blood and/or thick mucus
• Wheezing or shortness of breath
• Chronic lung or sinus infections
• Growths in the nose
• Inadequate growth or weight gain in childhood
• Oily, foul-smelling stools
• Constipation
• Infertility 

Treatment of cystic fibrosis focuses on improving breathing and digestion, managing symptoms, and preventing and treating infection.

Pulmonary embolism

Pulmonary embolism (PE) is a sudden blockage in a lung artery usually caused by a blood clot in the leg that travels through the bloodstream to the lungs.

It’s a serious condition that can be life-threatening.

About 50% of people who have PE have no symptoms, but if symptoms occur they can include: 

• Shortness of breath
• Chest pain
• Coughing up blood

If you’re diagnosed with PE, the goal of treatment is to break up the blood clot and prevent others from forming.

This can be accomplished through certain medicines (including blood thinners) and some procedures.

Lung cancer

Coughing up blood can be a late symptom of lung cancer, usually accompanied by other symptoms such as:

• Weight loss
• Change in cough
• Fatigue
• Other chronic symptoms

Lung infections or inflammation

One study estimates that infectious and inflammatory lung diseases make up 25.8% of hemoptysis cases.

Bronchitis and pneumonia are two of the more common infectious and inflammatory causes of hemoptysis, especially in the western countries (tuberculosis isn’t a common cause of hemoptysis in the United States, but is the most common cause of the condition in developing countries).

Bronchitis occurs when the tissues that carry air to the lungs become inflamed, narrowing the airways.

Acute bronchitis is usually a result of having a flu or cold-like illness.

Symptoms of bronchitis are: 

• Difficulty breathing
• Coughing up mucus and/or blood

Pneumonia is an infection of the lungs that causes the air sacs to fill with fluid or pus.

It also often develops after a flu or cold-like illness.

Symptoms of pneumonia are: 

• Fever
• Chills
• Shortness of breath
• Chest pain while coughing
• Coughing up mucus and/or blood

Congestive heart failure

Coughing up blood-tinged, white, frothy mucus can be a sign of congestive heart failure.

It is a complex condition that occurs when the heart can’t pump enough blood to meet the body’s requirements.

Congestive heart failure can be caused by structural or functional abnormalities of the heart, coronary artery disease, type 2 diabetes, and heart attack. 

Commonly reported symptoms of congestive heart failure include:

• Shortness of breath
• Chest pain
• Heart palpitations
• Anorexia
• Fatigue
• Coughing up blood

Injury

Injury to the arteries of the lungs can also cause hemoptysis.

In some cases, surgery may be necessary to repair the artery or lung.

Diagnosis

It’s important to speak with a medical provider if you’re coughing up blood.

A provider can help to diagnose the cause of your hemoptysis and recommend a treatment plan. 

Physical exam

During the visit, your provider will ask about your symptoms and coughing history (including how much blood you’re coughing up), health history, any known exposures, and perform a physical examination.

During the physical examination, they will assess the health of your chest and lungs.

Lab testing

Your provider may order several tests to assess the health of your blood and lungs, including:

• Sputum culture and smear, to check for infection
• Prothrombin time (PT) or partial thromboplastin time (PTT), to measure the time it takes for your blood to clot
• Complete blood count
• TB skin test or blood work 

Imaging

Imaging tests may also aid your diagnosis, such as: 

• Chest CT scan
• Chest x-ray
• Lung scan

Bronchoscopy

Your provider may recommend performing a bronchoscopy to get a better look at the health of your lungs. A bronchoscopy is a type of endoscopy that allows your provider to look inside your lungs.

The instrument used has a small camera attached to a long, thin tube.

Treatment 

Treatment will depend on the cause of your hemoptysis, which is why consulting with a medical provider is essential to determining the right course of treatment for your symptoms.

Treatment options may include:

• Medications
• Radiation and chemotherapy
• Lifestyle changes
• Surgery or other procedures

When To See a Medical Provider

Because there are so many possible causes, some of which can be serious, it’s important to reach out to your healthcare provider if you’re coughing up blood and/or mucus. 

Additional symptoms that can be a sign of a medical emergency include:

• Chest pain
• Blood in urine or stools
• Dizziness or lightheadedness
• Shortness of breath
• Rapid or severe weight loss

How K Health Can Help

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