17696 Coughing Up Blood

Overview

Coughing up blood means blood comes up from your lungs or breathing tubes (airways) when you cough. Doctors call it haemoptysis (say: hee-MOP-tih-sis). The blood can be bright red, pink and frothy, or mixed in with phlegm (the mucus you cough up). It is different from blood that comes from your nose and drips down the back of your throat, and different from blood you vomit up from your stomach. Coughing up blood can look frightening, and it is always worth getting checked — but in many cases the cause is something treatable, such as a chest infection.

Coughing up small amounts of blood is fairly common, especially during chest infections, and is often not serious. Coughing up larger amounts is much less common and needs urgent medical attention.

It can affect anyone at any age. It is more likely in people who smoke or have smoked, people with long-term lung conditions such as bronchiectasis (widened, damaged airways) or COPD (long-term lung disease), people with cystic fibrosis, people taking blood-thinning medicines, and people who have recently had a chest infection. In children, a swallowed object stuck in the airway is one possible cause.

Symptoms

Common symptoms

• Blood-streaked phlegm when you cough
• Bright red or pink, frothy blood coming up with a cough
• A cough that has lasted a while, sometimes with mucus
• Chest discomfort or a tickle that triggers coughing
• Feeling tired or mildly breathless
• A recent cold, flu, or chest infection

Symptoms in children

• Blood-tinged spit after a nosebleed — the blood can run down the throat and be coughed up
• Coughing or choking after playing with small objects or food
• A cough that starts suddenly and will not stop
• Fever or breathing faster than usual with a chest infection
• In babies, any blood in spit or vomit should be checked the same day

Symptoms in older adults

• Blood in the cough along with increasing breathlessness
• New or worsening cough in someone with a long-term lung condition
• Feeling dizzy or faint, which can be a sign of losing more blood than expected
• Blood in the cough while taking blood-thinning medicine — this needs prompt review
• Confusion or unusual drowsiness with breathing difficulty

Causes

Main causes

• Chest infections such as bronchitis (inflammation of the airways) or pneumonia (lung infection) — the most common cause of small streaks of blood
• Bronchiectasis — airways that are widened and damaged, which can bleed easily
• A long-term cough that irritates and bursts small blood vessels in the throat or airways
• Blood running down the back of the throat from a nosebleed
• A blood clot in the lung (pulmonary embolism)
• Tuberculosis (TB) — an infection that affects the lungs, more common in some parts of the world
• Lung cancer — uncommon but an important reason to get checked, especially in smokers or ex-smokers over 40
• Blood-thinning medicines, or a bleeding disorder
• Injury to the chest
• A swallowed object stuck in the airway (more common in young children)
• Cystic fibrosis or other inherited lung conditions
• In rare cases, conditions affecting the blood vessels in the lungs

Risk factors

• Smoking or a history of smoking
• A long-term lung condition such as COPD, bronchiectasis, or cystic fibrosis
• A recent or current chest infection
• Taking blood-thinning medicine
• A bleeding disorder
• Living in or travelling to an area where TB is common
• A job or hobby that involves breathing in dust, fumes, or asbestos
• A family history of lung disease or lung cancer
• A recent chest injury or a procedure on the lungs or airways

When to see a doctor

See a doctor urgently if:

• You have coughed up blood for the first time — book an urgent appointment the same day
• The amount of blood is increasing, or it keeps coming back
• You feel breathless, dizzy, or unusually tired
• You have chest pain or a fever with the blood
• You take blood-thinning medicine and notice blood in your cough

Book a routine appointment if:

• You have coughed up a small streak of blood once and feel otherwise well — still make an appointment soon
• You have a cough that has lasted more than three weeks
• You have noticed unexplained weight loss, night sweats, or a change in your voice
• You have a long-term lung condition and your cough has changed
• You are worried and not sure whether it matters — it is always reasonable to ask

Diagnosis

Your doctor will start by asking questions: how much blood you saw, what colour it was, how often it happens, whether you have other symptoms, and whether you smoke or take any medicines. They will check your breathing, listen to your chest, and look in your nose and throat to see whether the blood is coming from there instead. Based on this, they may arrange tests. Many people are found to have a simple, treatable cause.

Tests that may be done

• A chest X-ray to look at the lungs
• Blood tests to check for infection, anaemia (low red blood cells), and how well your blood clots
• A sample of your phlegm to look for infection
• A CT scan of the chest for a more detailed picture of the lungs
• Bronchoscopy — a thin, flexible tube with a camera passed gently through the nose or mouth to look inside the airways. It is done with numbing medicine and you can usually go home the same day
• Tests for tuberculosis (TB) if there is a reason to suspect it
• A check of your nose and throat if the bleeding may be coming from there
• Lung function tests (breathing tests) if a long-term lung condition is suspected

What to expect at your appointment

You may not get an answer on the first visit. Your doctor will often start with simple tests and only arrange more detailed ones if needed. It helps to note down how much blood you saw, what it looked like, and when it happened. Ask your doctor to explain what they are checking for and when you should expect results — and ask what to do if the bleeding gets heavier in the meantime.

Treatment

Treatment depends entirely on the cause. If an infection is responsible, it usually clears with the right treatment. If a long-term lung condition is found, the focus is on managing it well. If the bleeding is heavy or keeps returning, you may be cared for in hospital where the team can stop it and protect your breathing. Your doctor will explain the options that fit your situation.

Self-care at home

• Note the amount, colour, and frequency of any blood so you can tell your doctor
• Rest and avoid strenuous activity while you are being checked
• Do not smoke, and avoid smoky or dusty places
• Drink fluids if you have a chest infection, unless your doctor has told you to limit them
• Do not stop or change any prescribed medicine — especially blood thinners — without speaking to your doctor or pharmacist first
• Keep your follow-up appointments and go back if things change

Medical treatments

If an infection is the cause, your doctor may prescribe treatment to clear it. If you have a long-term lung condition, they will review your regular treatment and help you manage flare-ups. For more significant bleeding, hospital teams can use a camera test to locate and treat the bleeding area, or a procedure to block the small blood vessel that is bleeding. In some cases, a small balloon or other device is used to protect the airway. Your doctor will discuss which approach is safest for you, taking into account your other health conditions and any medicines you take.

When is surgery considered?

Surgery is only needed in a small number of cases — for example, when bleeding keeps coming back, cannot be controlled with other treatments, or when a specific lung problem such as a damaged part of the lung or a tumour needs to be removed. Your specialist team would discuss this carefully with you, including the benefits and risks.

Living with this condition

After you have been checked, most people can carry on with normal life while the cause is treated. Keep an eye on your cough and note any changes. If you have a long-term lung condition, keeping up with your usual treatment plan, avoiding smoke, and staying active all help. Have a plan for what to do if bleeding starts again — know your local emergency number and when to use it.

Lifestyle tips

• Stop smoking — ask your doctor, pharmacist, or local stop-smoking service for support
• Avoid breathing in smoke, dust, fumes, and strong chemicals
• Keep rooms well ventilated and use a mask if you work in a dusty environment
• Stay up to date with recommended vaccinations
• Manage conditions like asthma or COPD with your regular treatment plan
• Eat a balanced diet and keep active to support your general health and breathing

Diet and exercise

There is no special diet that stops coughing up blood, but eating well and drinking enough help your body recover, especially after an infection. Gentle activity such as walking is good for your lungs and mood. Build up slowly if you have been unwell, and check with your doctor before starting vigorous exercise if you are still being investigated or feel breathless. Avoid very strenuous activity while the cause is still being looked into.

Mental health and emotional wellbeing

Coughing up blood can be very frightening, and it is completely normal to feel anxious or to worry about what it means. Anxiety can make you breathe faster and feel even more breathless, which can feel like a loop. Talking about your worries with your doctor, a nurse, or someone you trust often helps. If you feel overwhelmed, or if you have thoughts of harming yourself, contact your local emergency number or a crisis support service in your country straight away — you deserve help and you are not alone.

Prevention

Some causes can be prevented or made less likely. Not smoking, or stopping smoking, is the single most helpful step for your lungs. Treating chest infections promptly, avoiding lung irritants, and managing long-term lung conditions well all reduce the chance of problems. Some causes, such as an injury or a blood clot, cannot be predicted.

Vaccines

Staying up to date with the vaccinations your local health service recommends — such as flu, pneumonia, COVID-19, and whooping cough where appropriate — can reduce the risk of chest infections that sometimes cause blood in the cough. Ask your doctor or pharmacist which ones are right for you.

Screening programmes

There is no routine screening test for coughing up blood itself. Some countries offer lung cancer screening to people at higher risk, such as certain older adults with a smoking history. If you smoke or have smoked, ask your doctor whether a lung health check is available where you live.

Complications

If left untreated

• Losing enough blood to cause anaemia (low red blood cells) and tiredness
• Blood blocking part of the airway and making it harder to breathe
• Low oxygen levels in the body if breathing is affected
• A serious underlying condition, such as an infection or a tumour, going unnoticed for longer
• In heavy bleeding, a drop in blood pressure that needs emergency care

Long-term outlook

The outlook depends on the cause, and many causes are treatable. Small streaks of blood from a chest infection usually settle completely. Long-term lung conditions can be managed well with the right care, and even serious causes have more treatment options today than ever before. The most important thing is to get checked early, keep your follow-up appointments, and tell your doctor if anything changes.

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