Coughing Up Blood

Overview

Coughing up blood — doctors call it haemoptysis (say: heh-MOP-tih-sis) — means you bring up blood from your lungs or breathing tubes when you cough. 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, mouth or gums, and different from vomiting blood, which usually comes from the stomach and looks darker, like coffee grounds. Coughing up blood can be a sign of something minor, like a chest infection, or something that needs prompt attention. That is why it should always be checked by a doctor.

Small amounts of blood mixed with phlegm are fairly common, especially during chest infections and in people who cough a lot. Coughing up larger amounts of blood is much less common and needs to be checked quickly.

It can affect anyone at any age, but it is more likely in people who smoke or vape, people with long-term lung conditions such as asthma, COPD or bronchiectasis (damaged, widened airways), people taking blood-thinning medicines, people with bleeding problems, and people with a serious infection such as pneumonia or tuberculosis (TB).

Symptoms

Common symptoms

• Streaks of bright red or pink blood in your phlegm
• Coughing up frothy blood, which can look like pink bubbles
• A cough that has lasted for days or weeks
• Wheezing or noisy breathing
• Feeling short of breath, especially with activity
• Chest pain, particularly when breathing deeply or coughing
• Fever, chills or feeling generally unwell
• A sore throat or a feeling of irritation in the chest

Symptoms in children

• Coughing up blood is uncommon in children. In children, blood in the mouth often comes from a nosebleed that has trickled down the back of the throat, or from bleeding gums or a mouth injury.
• Children may swallow blood and then cough or vomit it back up, which can be confusing for parents to tell apart.
• Even a small amount of blood should be checked by a doctor, because children are less able to describe how they feel.
• In a child, coughing blood with a fever, fast breathing, or a foreign object stuck in the airway needs urgent medical attention.

Symptoms in older adults

• Older adults may have a more serious cause, so blood in phlegm is taken seriously even when the amount is small.
• Blood-thinning medicines are more common in this age group and can make any bleeding heavier or last longer.
• Fever or infection may be less obvious — confusion, tiredness or a fall can sometimes be the main sign.
• Breathlessness and low oxygen levels can come on faster, so early assessment is important.

Causes

Main causes

• Chest infections such as bronchitis (swelling of the breathing tubes) or pneumonia (a lung infection)
• Irritation or inflammation of the airways from coughing, smoke or allergies
• Asthma or COPD (chronic obstructive pulmonary disease) flare-ups
• Bronchiectasis — airways that are damaged and widened, which can bleed easily
• Tuberculosis (TB), a bacterial lung infection
• A blood clot in the lung (pulmonary embolism)
• Lung cancer, which is why any unexplained blood in phlegm is checked
• Heart failure causing fluid to build up in the lungs
• Blood-thinning medicines or a bleeding disorder
• Injury to the chest or a foreign object in the airway
• Blood from the nose, gums or throat that trickles down and is coughed back up

Risk factors

• Smoking or vaping, or breathing in a lot of second-hand smoke
• Living or working with dust, fumes, asbestos or other lung irritants
• A long-term lung condition such as asthma, COPD or bronchiectasis
• Taking blood-thinning medicines or having a bleeding disorder
• A weakened immune system from illness or certain treatments
• Close contact with someone who has TB, or having lived in a part of the world where TB is common
• A previous history of cancer, TB or a collapsed lung
• Recent surgery or a procedure on your chest, throat or lungs

When to see a doctor

See a doctor urgently if:

• You cough up more than a few teaspoons of blood, or it does not stop — call emergency services
• You have severe breathlessness, chest pain, fainting or blue lips — call emergency services
• You cough up any blood while taking a blood thinner — contact your doctor or urgent care the same day
• You have blood in your phlegm with fever, night sweats or weight loss — get seen the same day
• You have a new or worsening cough with blood — book an urgent appointment

Book a routine appointment if:

• You notice a small streak of blood once and feel otherwise well — still book an appointment to get it checked
• You have a cough that has lasted more than three weeks, even without blood
• You have repeated chest infections
• You have a long-term lung condition and notice blood in your phlegm
• You want advice about stopping smoking or about lung health

Diagnosis

Your doctor will start by asking questions: how much blood you have coughed up, what colour it was, whether it was mixed with phlegm, how long it has been happening, and whether you have other symptoms such as fever, breathlessness, weight loss or chest pain. They will ask about your medical history, medicines, smoking and any contact with TB. Then they will examine you — listening to your chest with a stethoscope, checking your breathing rate and oxygen level, and looking at your nose, mouth and throat to see whether the blood is coming from there instead.

Tests that may be done

• A chest X-ray, which is usually the first test
• Blood tests to check for infection, anaemia and how well your blood clots
• A phlegm sample to look for infection, including TB
• A CT scan of the chest for a more detailed picture
• A bronchoscopy — a thin flexible tube with a camera passed gently down the airway to look inside and, if needed, take a small sample
• Lung function tests to see how well your lungs are working
• An oxygen level check (a small clip on your finger) or a blood gas test
• Tests for blood clots if a clot in the lung is suspected

What to expect at your appointment

Most people start with a conversation, an examination and a chest X-ray, and often that is enough to find the cause. Some tests, like blood tests and an X-ray, can be done the same day. Others, like a CT scan or bronchoscopy, are usually arranged within a few days or weeks. Waiting for results can feel stressful — it can help to bring someone with you, write down your questions, and ask your doctor when and how you will hear back.

Treatment

Treatment depends entirely on the cause. The aim is to stop or control the bleeding and to treat whatever is behind it — an infection, an inflamed airway, a blood clot or another condition. Your doctor will explain the options and involve you in decisions.

Self-care at home

• Note down how much blood you coughed up, what colour it was and when it happened, so you can tell your doctor
• Rest and drink plenty of fluids while you recover
• Do not smoke or vape, and avoid smoky or dusty places
• Avoid very strenuous activity until your doctor has checked you
• Do not stop any prescribed medicine, especially a blood thinner, without speaking to your doctor or pharmacist first
• Keep any follow-up appointments and test results in mind — ask for them if you have not heard back
• If bleeding gets heavier, or you feel very unwell or breathless, call emergency services straight away

Medical treatments

Doctors treat the underlying cause. If there is an infection, they may prescribe medicines to fight it. If the airways are inflamed, they may prescribe inhaled or tablet medicines to open the airways and reduce swelling. If a blood clot is found, treatment to thin the blood is used. If bleeding is coming from a small blood vessel, a procedure may be used to seal it. Your doctor will also review any medicines that could make bleeding more likely, such as blood thinners, and adjust them safely with you. You should never change or stop a prescribed medicine on your own.

When is surgery considered?

Surgery is needed only in a small number of cases. It may be considered if bleeding is heavy or keeps coming back, or if a growth, a badly damaged part of the lung, or a foreign object needs to be removed. Most people with coughing up blood do not need an operation. Your specialist team will explain the risks and benefits if this applies to you.

Living with this condition

While you are being checked or recovering, take things a little easier than usual. Keep a simple record of any blood you cough up and how you feel, and tell your doctor about changes. Carry your medicine list and any allergy information with you. If you have a long-term lung condition, keep following your usual care plan and make sure you know what to do if your breathing gets worse.

Lifestyle tips

• Stop smoking — free support is available through your doctor or pharmacist, and it is the single biggest thing you can do for your lungs
• Avoid vaping and breathing in second-hand smoke
• Wear a mask if your work involves dust, fumes or fine particles
• Keep rooms well ventilated and avoid strong cleaning fumes or smoke from fires
• Stay up to date with recommended vaccinations
• Get enough rest, and build activity back up gradually after an infection

Diet and exercise

There is no special diet that stops coughing up blood, but eating well and drinking enough fluids helps your body recover, especially after an infection. Gentle activity such as short walks is fine once you feel up to it, and builds stamina over time. Avoid heavy lifting or very intense exercise until your doctor says it is safe. If you have a long-term lung condition, ask about a pulmonary rehabilitation programme — a friendly, supervised exercise and education course that many people find very helpful.

Mental health and emotional wellbeing

Coughing up blood can be frightening, and it is very normal to feel anxious or to keep checking your phlegm. Waiting for test results can be an especially worrying time. Talking to someone you trust, writing down your questions, and asking your doctor to explain things plainly can all help. If worry is affecting your sleep, appetite or mood, tell your doctor — support such as talking therapies is available and really can help. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis support service straight away.

Prevention

Not all causes can be prevented, but you can lower your risk. Not smoking, avoiding smoke and dust, treating chest infections early, and keeping long-term lung conditions well controlled all make a real difference. If you take a blood thinner, have regular reviews with your doctor or pharmacist so your dose stays right for you.

Vaccines

Vaccines help prevent some of the infections that cause coughing up blood. Ask your doctor or pharmacist whether you are up to date with the flu vaccine, COVID-19 vaccines, and the pneumococcal vaccine (which protects against a common cause of pneumonia). Some countries also recommend a whooping cough vaccine in pregnancy and a shingles vaccine for older adults — your local health service can advise what applies to you.

Screening programmes

There is no routine screening test for coughing up blood itself — the symptom is what prompts a check. Some countries offer lung cancer screening, such as a low-dose CT scan, to people at higher risk (for example, certain older adults with a long smoking history). Ask your doctor whether screening is available and recommended for you.

Complications

If left untreated

• Losing enough blood to cause anaemia (low iron), which brings tiredness and breathlessness
• Blood blocking part of the airway, making breathing harder
• Low oxygen levels in the body, which can affect the heart and brain
• An infection or a serious condition going undiagnosed and getting worse
• Heavy bleeding that becomes an emergency
• Ongoing worry and loss of sleep from not knowing the cause

Long-term outlook

The outlook is good for most people. Many causes — chest infections, irritated airways, asthma flare-ups — settle with treatment, and the bleeding stops. When something more serious is found, being checked early means it can be treated sooner, and treatments continue to improve. Whatever the cause, your medical team will work with you on a plan, and support is available at every step.

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