Blood from coughing hard

Coughing up blood (blood in phlegm)

Coughing up blood can be alarming, but isn't necessarily a sign of a serious problem. It's more likely to be a cause for concern the older you are, particularly if you smoke. You should see your GP as soon as possible if you cough up blood.

About coughing up blood

In up to one in five cases investigated, no cause is found for coughing up blood.

If you are coughing up blood, you may cough up:

small amounts of bright red blood
frothy blood-streaked sputum – sputum is saliva (liquid produced in your mouth) and phlegm (a thick liquid produced, especially when a person has a cold)

The blood is usually from your lungs. It’s often the result of coughing for long periods or a chest infection.

Mostly, if you cough up blood, the bleeding will stop on its own. In about five per cent of people (who cough up blood for the first time) the bleeding will be severe.

This bleeding can be life threatening - call 999 if this is happening.

If the blood is dark and contains bits of food or what looks like coffee grounds, it may be coming from your digestive system.

This may also be a serious problem. You should go to hospital straight away if you vomit up blood.

Read more about vomiting blood

What to do if you cough up blood

See your GP as soon as possible if you cough up blood. It's particularly important to see your GP if:

you cough up more than a few teaspoons of blood
you also have chest pain, dizziness, fever, light-headedness or worsening shortness of breath
you have a loss of appetite or unexplained weight loss
there's also blood in your urine or blood in your stools

Your GP will be able to assess whether you may have a serious medical condition that needs to be investigated and treated. Call GP out of hours service if you can't see your GP.

Call 999 for an ambulance or go to your nearest emergency department immediately if you're coughing up significant amounts of blood or are struggling to breathe.

Tests that may be needed

You may be asked for a sample of your sputum so it can be checked for infection. Other tests, such as blood tests, may also be needed.

Your GP may decide to refer you to a specialist at your local hospital. Tests that may be carried out include a:

chest X-ray
more detailed scan, such as a computerised tomography (CT) scan

In some cases, further tests may be required to find out where the blood is coming from. For example, you may have a test called a bronchoscopy. This is where the main air passages of your lungs are examined using a tube with a camera at one end.

Common causes of coughing up blood

The information below can give you a better idea of what may be the reason for coughing up of blood.

Don't use it to diagnose yourself - always leave that to a doctor.

The most common reason for coughing up blood is a chest infection.

Where a specific cause is found, the most common causes include:

pneumonia - a swelling (inflammation) of the tissue in one or both of your lungs usually caused by an infection with a germ (bacterium or virus)
bronchitis - an infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed (it can be caused by either a virus or bacteria, although viral bronchitis is much more common)
tuberculosis (TB) – a severe lung infection associated with fever and sweating which can be treated with antibiotics

Sometimes a severe nosebleed or bleeding from the mouth or throat can cause blood to come out in your saliva when you cough.

Less common causes of coughing up blood

Less commonly, coughing up blood may be the result of:

bronchiectasis – this is more likely if you're also wheezy or short of breath
pulmonary embolism (a blood clot in the lungs) – this usually causes sudden shortness of breath and chest pain
pulmonary oedema (fluid in the lungs) – your sputum will be pink and frothy, and this usually occurs in people with pre-existing heart problems
lung cancer – this is more likely if you're over 40 and smoke
cancer of the throat or windpipe
taking anticoagulants – medications that help stop your blood clotting, such as warfarin or other oral anticoagulants

Sometimes, in 15 to 20 per cent of cases, no cause can be found and it never happens again.

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What to do next

Hemoptysis (Coughing Up Blood): Causes, Diagnosis, and Treatment

Written by Matthew Hoffman, MD

Medically Reviewed by Paul Boyce, MD on August 19, 2022

What Is Hemoptysis?

Hemoptysis is when you cough up blood from your lungs. It can be a sign of a serious medical condition. Infections, cancer, and problems in blood vessels in your lungs can cause it. Unless you have bronchitis, you need to see a doctor if you’re coughing up blood.

Hemoptysis is divided into types based on how much blood you cough up over 24 hours. But in some cases, it can be hard to tell.

Life-threatening or massive hemoptysis. Different experts have different guidelines for what this type involves. They range from 100 milliliters (mL) of blood to over 600 mL, or about a pint.

Non-life-threatening or non-massive hemoptysis. This is also known as moderate or submassive hemoptysis. You may cough up between 20 and 200 mL (about a cup) of blood.
Scant or mild hemoptysis. You cough up less than 20 mL, less than a tablespoon.

Hemoptysis Causes

Many things can make you cough up blood. Common causes include:

Bronchitis, either short-term (acute) or long-term (chronic)
Lung cancer
Damaged airways (bronchiectasis), especially because of cystic fibrosis
Pneumonia
Tuberculosis
Chronic obstructive pulmonary disease (COPD)

Other causes include:

Congestive heart failure, especially because of mitral stenosis
Crack cocaine use
Foreign objects in your airways
Inflammatory or autoimmune conditions (such as lupus, granulomatosis with polyangiitis, microscopic polyangiitis, Churg-Strauss syndrome, Goodpasture disease, or Behcet disease)
Lung abscess
Non-cancerous lung tumors
Parasitic infection
Pulmonary arteriovenous malformations (AVMs)
Pulmonary embolism
An injury like a gunshot wound or car accident
Use of blood thinners (anticoagulants)
Endometriosis
Hughes-Stovin syndrome
Hereditary hemorrhagic telangiectasia
Sarcoidosis

In some cases, doctors can’t find a cause, but the hemoptysis usually goes away within 6 months.

Hemoptysis vs. Similar Conditions

Your doctor will need to find out whether the blood is coming from your lungs, which is hemoptysis, or from your upper respiratory tract or upper digestive tract. This is called pseudohemoptysis. Or you could be vomiting blood, which is known as hematemesis.

Hemoptysis causes sputum (the material you cough up) that’s bright red or pink and frothy.
Pseudohemoptysis looks very similar. Tests might be the only way to tell the difference.
Hematemesis brings up material that’s darker and looks like coffee grounds. It may be mixed with bits of food.

When to see a doctor

Acute bronchitis typically gets better on its own without treatment. If you have bronchitis and see small amounts of blood in the mucus for less than a week, it’s OK to watch and wait.

Coughing up blood can also be a sign of a serious medical condition. Call your doctor if you have any of these symptoms:

Blood in mucus that lasts longer than a week, is severe or getting worse, or comes and goes over time
Chest pain
Weight loss
Soaking sweats at night
Fever higher than 101 degrees
Shortness of breath with your usual activity level

Hemoptysis Diagnosis and Tests

If you’re coughing up blood, your doctor will do one or more of these:

Medical history and physical exam . This helps them gather clues to identify the cause.
Chest X-ray. This can show whether there’s a mass in your chest or areas of fluid or congestion in your lungs.
CT scan . With detailed images of the inside of your chest, this test may reveal some causes for coughing up blood.
Bronchoscopy . Your doctor runs a flexible tube with a camera on its end, called a bronchoscope, through your nose or mouth and into your windpipe and airways.
Complete blood count (CBC). This test checks the number of white and red blood cells in your blood, along with platelets (cells that help blood clot).
Urinalysis . Some causes of hemoptysis also show up on this simple urine test.
Blood chemistry profile. This test measures electrolytes and how well your kidneys are working.
Coagulation tests. Changes to your blood’s ability to clot, or coagulate, can lead to bleeding and coughing up blood.
Arterial blood gas. This test measures the levels of oxygen and carbon dioxide in your blood. Oxygen levels can be low in people coughing up blood.
Pulse oximetry. A probe (usually on a finger) tests the level of oxygen in your blood.

Hemoptysis Treatments

Treatment for hemoptysis depends on how much blood you’re coughing up and what’s causing it.

Life-threatening or massive hemoptysis

Your doctor will move you into the hospital’s intensive care unit (ICU). They may have you see a pulmonologist and a cardiothoracic surgeon, doctors who specialize in the chest and respiratory tract.

Your first treatment could include:

A tube that goes into your airways (intubation)
Extra oxygen (ventilation and oxygenation)
A body position in which the lung with possible bleeding is lower than the other lung

When your doctor finds the source of the bleeding, they might try to stop it with:

Iced saline
Medications to narrow blood vessels (vasoconstrictors) like epinephrine or vasopressin
Medicines to help blood clot (coagulants) like tranexamic acid
Tiny balloons or cuffs to put pressure on the area (bronchial blockade or balloon tamponade)
Laser therapy
Argon plasma coagulation (APC)
Cryotherapy
Embolization

In rare cases, you may need surgery. This could involve:

Taking out one section (lobe) of your lung
Removing the entire lung

When you’re out of danger, your doctor will treat what’s making you cough up blood. You might get:

Antibiotics for pneumonia or tuberculosis
Chemotherapy or radiation for lung cancer
Steroids for inflammatory conditions

If you have very thin blood because of medications, you may need transfusions of blood products or other medications to ease blood loss.

Nonlife-threatening or nonmassive hemoptysis

Treatment for the underlying condition will usually take care of bleeding that isn’t dangerous. If you have bronchitis, the most common cause of hemoptysis, your doctor may give you antibiotics. They might also recommend cough medicine.

If you smoke cigarettes, stop. It’s the best thing you can do for hemoptysis and for your overall health.

Cough with blood

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Cough with blood - the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Cough is one of the most common symptoms of respiratory diseases.

But if the cough is accompanied by the separation of not ordinary sputum, but with streaks and even blood clots, this is an alarming signal that may indicate a serious illness.

To denote the release of blood from the respiratory organs, a special term was introduced - hemoptysis. The volume of blood excreted with sputum varies: it can be single streaks of blood to massive bleeding. The development of bleeding is accompanied by shortness of breath, pain, a feeling of warmth or burning in the chest.

It should be remembered that, regardless of the amount of blood in the sputum, hemoptysis is a dangerous condition and requires seeking medical help to identify and eliminate the causes that led to the appearance of this symptom.

Types of hemoptysis

It is important to distinguish between true and false hemoptysis.

True hemoptysis occurs when blood flows out of the vessels of the respiratory system. In this case, blood can mix with sputum and saliva.

False hemoptysis occurs when blood enters the respiratory organs from other organs, for example, from the stomach during gastric bleeding or from damaged vessels of the oral cavity.

Causes of hemoptysis

In most cases, the cause of hemoptysis is pathological changes in the vessels of the bronchi and lungs .

Of great importance is pulmonary tuberculosis and its complications. Mycobacterium tuberculosis in the course of the disease causes the destruction of lung tissue, sometimes with the formation of cavities (caverns). At the same time, the vascular bed is rebuilt: obliteration or growth of small vessels occurs, which causes subsequent bleeding.

Hemoptysis accompanies many infectious diseases of the respiratory system: bronchitis, pneumonia. Some bacteria have the ability to destroy lung tissue and increase pulmonary vascular permeability.

In the case of pneumonia, fever, chills, shortness of breath, chest pain, night sweats are added to the cough with blood streaks.

For children, hemoptysis is characteristic of aspiration (inhalation) of small objects - toys and their parts, pen caps, seeds.

If the foreign body has passed deeply, then there will be no pronounced shortness of breath and signs of suffocation. The only symptom may be a long, agonizing cough with a small amount of sputum, sometimes with blood.

Quite rarely, the cause of hemoptysis can be helminths (in particular, roundworms). During migration, parasites damage small vessels, which causes blood in the sputum.

Another cause of hemoptysis is bronchiectasis .

Bronchiectasis is an irreversible pathological expansion of the bronchi and bronchioles. Often occur in children with cystic fibrosis, with foreign body aspiration, whooping cough and frequent respiratory infections.

Sometimes bronchiectasis is congenital - in violation of the formation of the bronchial tree.

Quite often, the cause of blood when coughing is traumatic chest injury . Hemorrhage occurs in the lung tissue with the release of part of the blood with sputum.

In adult patients, the causes of blood when coughing are more often cardiovascular pathologies. In diseases of the heart muscle, whether it is myocardial infarction, myocarditis , blood stagnation occurs in the pulmonary circulation (in the lungs). Blood seeps through the capillary wall into the alveoli, the small sacs at the ends of the bronchi. The resulting mixture of alveolar fluid, bronchial mucus and blood comes out when you cough.

With a pronounced degree of acute heart failure, pink foam appears - an extreme manifestation of pulmonary edema.

Many heart defects also cause congestion in the lungs with shortness of breath and hemoptysis. With acquired heart defects, hemoptysis most often occurs in patients with mitral valve disease. Among the vascular diseases that cause sudden hemoptysis, we should highlight pulmonary embolism (TELA).

Hemoptysis accompanies about a third of all cases of PE. The main symptoms are severe shortness of breath, cough and chest pain.

More than half of patients with lung cancer have hemoptysis. The main risk group for the development of malignant neoplasms of the lungs includes smokers over 40 years of age. In the case of lung cancer, bleeding can occur when the tumor breaks down, after which the sputum mixes with blood and takes on the appearance of "raspberry jelly".

Benign lung tumors rarely cause hemoptysis.

Relatively rare causes of coughing up blood include aneurysm and subsequent vessel rupture into the bronchus.

Congenital pathology of the blood coagulation system, for example, hemophilia , can cause both acute pulmonary hemorrhage and prolonged hemoptysis, small in volume. Hemoptysis may be one of the symptoms of various autoimmune pathologies . So, for example, with granulomatosis with polyangiitis (Wegener's disease), inflammation of the vascular wall occurs with involvement of the upper and lower respiratory tract in the process.

Overdose of certain medicines with an increased risk of bleeding may lead to hemoptysis.

These drugs include: anticoagulants (warfarin, rivaroxaban, dabigatran), antiplatelet agents (acetylsalicylic acid, ticagrel).

The use of narcotic substances (in particular, cocaine) leads to damage to the vessels of the nasopharyngeal mucosa, followed by hemoptysis.

Which doctors should I contact if I cough up blood?

The appearance of blood when coughing requires a visit to a doctor of a therapeutic profile: therapist or pediatrician. After the examination, the doctor will prescribe a set of instrumental and laboratory tests and refer, if necessary, to a specialist. You may need to consult a pulmonologist, cardiologist, otolaryngologist, rheumatologist, phthisiatrician, oncologist.

If there is a suspicion of injury, heavy bleeding from the respiratory tract, dizziness, shortness of breath and rapid heartbeat, you should call an ambulance.

Diagnosis and examination for coughing up blood

During the examination, the following is carried out:

clinical blood test;

Treatment of cough with blood

Depending on the amount of blood lost and the causes of the cough with blood, the doctor will prescribe various therapeutic measures.

Self-treatment is unacceptable, because it can lead to severe complications and death.

With heavy bleeding, surgical methods for stopping bleeding, transfusion of blood and its components are used.

If the cause of coughing up blood is tuberculosis or destructive pneumonia, various antibacterial drugs are prescribed. In the case of autoimmune pathology, immunosuppressive therapy with the use of glucocorticosteroids or cytostatics is used.

Treatment of cardiovascular pathology depends on the level of damage and the mechanism of development: for congestion in the pulmonary circulation due to heart failure, diuretic (diuretic) therapy is used, for pulmonary embolism - conservative (thrombolysis) or surgical methods of treatment and prevention of recurrent thrombosis.

If the bleeding is caused by medication, the doctor will adjust the therapy or note it if necessary.

What if you cough up blood?

In case of heavy bleeding, respiratory failure, loss of consciousness, severe pallor, palpitations, you should immediately call an ambulance.

If a person is conscious, you should calm him down, ask him not to talk, give him a semi-sitting position or lying on his side to avoid blood entering the respiratory tract.

If hemoptysis is accompanied by a small amount of blood, you should seek medical help for a thorough examination.

To reduce the risk of bleeding, it is necessary to stop smoking, walk in the fresh air, and, as prescribed by a doctor, perform breathing exercises and physical exercises.

Sources:

Clinical guidelines "TB in adults". Developed by: Russian Society of Phthisiologists, Association of Phthisiologists. – 2022.

Clinical guidelines "Tuberculosis in children". Developed by: Russian society of phthisiatricians. – 2020.
Clinical guidelines "Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension". Developed by: Russian Society of Cardiology, Association of Cardiovascular Surgeons of Russia, Federation of Anesthesiologists and Resuscitators, Association of Rheumatologists of Russia, Russian Respiratory Society, National Congress of Radiologists. – 2020.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes over time, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Cough with blood (hemoptysis) - causes, what to do, treatment

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The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Contents of the article

Types of spitting (cough) with blood

Causes

Which doctors to contact

Diagnostics

Treatment

Preventive measures

What is coughing up blood?

The most alarming symptom in various respiratory pathologies is undoubtedly cough with blood or hemoptysis . This is a condition in which coughing is accompanied by sputum with blood streaks or clots. This symptom indicates rather serious, severe disorders in the functioning of the respiratory tract, damage to the integrity of the bronchopulmonary system, perforation of individual structures.

The appearance of blood when coughing should be an occasion for immediate medical attention and a complete examination. If this symptom is ignored, irreversible changes in the respiratory system and complications, up to and including death, are possible.

Types of coughing (cough) with blood

Blood can be secreted from various parts of the respiratory tract. In addition, it can enter the sputum from other tissues and organs not related to the respiratory system. In this regard, two types of situations are distinguished when a patient can spit blood.

True hemoptysis with damage to the lungs and bronchi. In this case, the blood is mixed with saliva and sputum when coughing.

Foot hemoptysis occurs when blood enters from the nasopharynx in case of damage to the vessels of the nose, from the esophagus or stomach in case of reflux. In this case, the blood is mixed only with saliva or nasal mucus. Source:
Difficult patient or patient with hemoptysis. Krenev K., Kabysh Ya., Yudin O. Sciences of Europe No. 48, 2020. pp. 17-22.

Causes

Pneumonia – various types of inflammation of the lung parenchyma. They may be caused by bacteria or viruses

Tuberculous infection affecting lung tissue

Cystic fibrosis in children . This is a genetic disease in which mucus is too thick in the bronchi, which often becomes infected and is difficult to cough up

Cancer of the lung or bronchi , in which tissue is gradually destroyed, metastases of other tumors

PE (stands for pulmonary embolism)

Increased pressure in the pulmonary venous system associated with heart or lung problems

Bronchial foreign bodies (food, small items). Edges damage tissues, inflammation increases destruction

Bronchiectasis with the formation of a severe deformation of the bronchial tree, the formation of non-functional air sacs at the ends of the bronchi, a tendency to infection of the affected tissues and damage, destruction of the lung tissue and small bronchi

Various forms of bronchitis , predominantly chronic course

By definition, bronchitis are inflammatory processes localized in the walls of the bronchi - flexible, elastic tubes through which air moves from the external environment through the upper respiratory tract to the lungs and back. Acute bronchitis is the result of respiratory viral, bacterial infections, exposure to allergens or chemical compounds. The chronic form of bronchitis is formed as a result of a prolonged inflammatory process in the walls of the bronchi during smoking, against the background of constant infections, irritation with industrial aerogenic substances (dust, soot, chemicals, asbestos cement).

Which doctor to contact

If you have a cough with blood, you need to see a doctor. This may be a local therapist or pediatrician (if the child has blood). After the initial examination, a detailed conversation and the identification of all related complaints, the doctor can send the patient for a consultation with a pulmonologist and at the same time prescribe a number of tests or studies.

In addition, diagnostics can be carried out by:

phthisiatrician;

oncologist;

thoracic surgeon;

otorhinolaryngologist;

cardiologist Source:
Hemoptysis: differential diagnostic aspects in the practice of a cardiologist. Trukhan D.I., Viktorova I.A., Viktorov S.I. Consilium Medicum No. 10, 2016. pp. 87-92;

rheumatologist.

If, when coughing, red blood comes out of the bronchi, copious clots, an ambulance call and hospitalization is necessary.

Diagnostic methods

sputum microscopy and culture that allow to confirm or exclude infectious lesions;

blood tests - general, biochemistry, coagulogram. According to their results, it is possible to determine infectious, inflammatory processes, coagulopathy, metabolic disorders, endocrine and even tumor processes, to clarify why there is blood when coughing;

to exclude cystic fibrosis, sweat analysis is taken to study its qualitative and quantitative composition;

prescribed bronchoscopy , which allows you to visually determine the source of bleeding in the bronchi;

chest X-ray or fluorography is being performed. These studies identify pneumonia, tuberculosis, abscesses, tumors, etc.;

undergoing CT or MRI , depending on the suspected pathologies. Source:
Hemoptysis: current approaches to diagnosis and therapy. Avdeev S.N. Practical pulmonology №3, 2010. pp.20-23.

Additionally, depending on the preliminary diagnosis being established, they may prescribe a Mantoux test, ECG, abdominal ultrasound, EFGDS, an examination by an ENT doctor.

Treatment

The doctor will determine what to do and what tactics to choose in the treatment, depending on how much blood is lost when coughing, what may be the causes of this condition and how long it lasts. But it is worth emphasizing that the appearance, re-occurrence of hemoptysis is not a reason for self-treatment. Any independent action can only harm, provoking massive bleeding.

If profuse bleeding is detected , surgical procedures are used to stop the bleeding. Additionally, blood transfusion or only individual components can be used.

In the infectious nature of hemoptysis , antibacterial drugs are used, in autoimmune pathologies, immunosuppressive treatment, hormones, cytostatics are used. For problems with the heart and blood vessels, therapy is selected depending on the level of damage. These can be diuretics, thrombolytics (for PE), dose adjustment of coagulants Source:
Treatment of patients with hemoptysis and pulmonary hemorrhage. Chikinev Yu.V., Pokatilov K.N., Drobyazgin E.A., Korobeinikov A.V. Acta Biomedica Scientifica No. 4(86), 2012. pp. 112-113.

Preventive measures

it is important to quit smoking, reduce alcohol intake to a minimum;

avoid contact with hazardous, irritating substances, toxins, use a mask and protective clothing when working with caustic dust;

often and for a long time to be in the fresh air, to lead the most healthy, active lifestyle;

ventilate working and residential premises, humidify, purify indoor air;

it is useful to eat the most healthy, balanced food in all components.

Treatment of patients with hemoptysis and pulmonary hemorrhage. Chikinev Yu.V., Pokatilov K.N., Drobyazgin E.A., Korobeinikov A.V. Acta Biomedica Scientifica No. 4(86), 2012. p.112-113

Hemoptysis: modern approaches to diagnosis and therapy. Avdeev S.N. Practical pulmonology №3, 2010. p.20-23

Difficult patient or patient with hemoptysis. Krenev K., Kabysh Ya., Yudin O. Sciences of Europe No. 48, 2020. p.17-22

Hemoptysis: differential diagnostic aspects in the practice of a cardiologist. Trukhan D.I., Viktorova I.A., Viktorov S.I. Consilium Medicum No. 10, 2016. pp. 87-92

Article published : 02/13/2014
Last update : 11/06/2022

See also

Pharyngitis

Whooping cough

Laryngitis

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