Haemoptysis Coughing Up Blood

Overview

Haemoptysis (say: heh-MOP-tih-sis) is the medical word for coughing up blood. The blood usually comes from your airways — the tubes that carry air in and out of your lungs — or from your lungs themselves. It can show up as streaks of blood mixed in with phlegm (the mucus you cough up), or as a mouthful of blood. Coughing up blood is not the same as vomiting blood, which comes from the stomach, or as a nosebleed that runs down the back of your throat. It can be a sign of something minor, like a chest infection, but because it can sometimes point to a more serious problem, it should always be checked by a doctor.

Coughing up blood is not something you see every day, but doctors see it quite often. In general practice and emergency departments it is a common reason for people to ask for help. Most cases turn out to have a treatable cause.

It can affect anyone at any age, from children to older adults. It is more likely in people who smoke or have smoked, people with long-term lung conditions, people with bleeding problems, and people taking medicines that thin the blood. In children, the blood often comes from the nose or from a mild throat or chest infection.

Symptoms

Common symptoms

• Blood-streaked phlegm (mucus) when you cough
• Coughing up small amounts of bright red or pink, frothy blood
• A tickling feeling in your throat before you cough up blood
• A cough that has been going on for a while
• Chest pain or discomfort when breathing
• Feeling short of breath
• Fever, chills or feeling generally unwell (often with an infection)
• A hoarse voice or a metallic taste in the mouth

Symptoms in children

• Blood that is actually coming from a nosebleed and running down the back of the throat
• Blood streaks in phlegm during a cold or chest infection
• A cough after swallowing a small object, which can irritate the airway
• Children often swallow blood and then vomit it, which can look alarming but is not the same as coughing it up — a doctor should still check

Symptoms in older adults

• Blood that may be more noticeable if you take blood-thinning medicines
• Coughing up blood alongside a chest infection, which can be more serious with age
• Feeling more tired, dizzy or weak than expected from the amount of blood lost
• A new or changing cough that does not settle — worth checking sooner rather than later

Causes

Main causes

• Chest infections such as bronchitis or pneumonia — the most common cause, especially in younger, otherwise healthy people
• Bronchiectasis, where the airways become widened and scarred and are prone to bleeding
• A blood clot in the lung (pulmonary embolism)
• Lung cancer — much less common than infection, but a reason why checks matter
• Tuberculosis (TB), an infection that is more common in some parts of the world
• Heart conditions, such as heart failure, that cause fluid to build up in the lungs
• Bleeding from the nose, mouth, throat or stomach that gets coughed up rather than coming from the lungs
• Medicines that thin the blood, which make any small bleed more noticeable
• A bleeding or clotting disorder
• Damage to the chest from an injury, or a small object stuck in the airway
• Rare conditions where blood vessels in the lung become inflamed (for example, vasculitis)

Risk factors

• Smoking, or having smoked in the past
• A long-term lung condition such as COPD, bronchiectasis or cystic fibrosis
• Taking blood-thinning medicines or having a bleeding disorder
• A recent chest infection or pneumonia
• Being older, especially over 40, when lung cancer becomes more likely
• A weakened immune system
• Recent travel to or living in an area where TB is common
• A family history of lung disease or blood clots
• Working with dust, asbestos or other substances that harm the lungs

When to see a doctor

See a doctor urgently if:

• You are coughing up more than a few streaks of blood, or the amount is increasing
• You feel breathless, dizzy, weak or unwell alongside the bleeding
• You have a fever, night sweats, or you are losing weight without trying
• You take medicine that thins the blood, or you have a bleeding disorder
• You have a long-term lung condition and the pattern of your cough has changed
• You have chest pain or a fast heartbeat

Book a routine appointment if:

• You noticed a small streak of blood in your phlegm once or twice and feel otherwise well
• You have a cough that has lasted more than three weeks, even without much blood
• You smoke or used to smoke and have a new or different cough
• You have had blood in your phlegm before and want to know whether it needs checking again

Diagnosis

Your doctor will start by talking with you and examining you. They will want to know how much blood you saw, what it looked like, how often it happens, and whether you have other symptoms such as breathlessness, fever or weight loss. They will ask about your medical history, your medicines, and whether you smoke. They will listen to your chest with a stethoscope and check your breathing, heart rate and oxygen levels. Based on what they find, they may arrange tests or refer you to a specialist.

Tests that may be done

• A chest X-ray to look for infection, growths or other changes in the lungs
• Blood tests to check your blood count, clotting and general health
• A sample of your phlegm to look for infection
• A CT scan of the chest, which gives a more detailed picture than an X-ray
• A test to check the oxygen level in your blood (a small clip on your finger)
• Bronchoscopy — a thin, flexible tube with a camera passed gently through your mouth to look inside the airways. This is done with sedation or numbing medicine so it is not painful
• Tests for specific conditions such as TB or a blood clot, if your doctor suspects them

What to expect at your appointment

Some tests, like an X-ray or blood test, can often be done the same day. Others may take a week or two to arrange. Sometimes all the tests come back normal and no cause is found — this happens fairly often and is usually reassuring, but your doctor will talk with you about whether any follow-up is needed. Waiting for results can feel stressful; it can help to bring someone with you to appointments and to write down your questions beforehand.

Treatment

Treatment depends completely on the cause. There is no single treatment for coughing up blood. Your doctor's first job is to work out why it is happening, and then to treat that condition. If you are coughing up a lot of blood at once, the priority is to stop the bleeding and keep your breathing safe, which usually means going to hospital.

Self-care at home

• Do not ignore it. Even a small streak that keeps coming back deserves a check-up
• Note down when it happens, roughly how much blood you see, and what colour it is — this helps your doctor a lot
• If you smoke, stopping is the single most helpful thing you can do for your lungs. Ask your doctor or pharmacist for support to quit
• Stay well hydrated and rest if you have a chest infection
• Avoid taking any new medicines, including over-the-counter ones, without checking with a pharmacist or doctor — especially anything that affects bleeding
• Keep any follow-up appointments, even if you feel better

Medical treatments

Once the cause is known, treatment is aimed at it. If an infection is the cause, your doctor may prescribe medicine to treat it. If the bleeding is heavy or keeps coming back, hospital teams have ways to seal or block the small blood vessels that are bleeding, using a camera through the airway or a procedure guided by X-ray. Oxygen and fluids may be given if you have lost blood or are struggling to breathe. If you take blood-thinning medicine, your doctor may adjust it, but never change or stop it on your own. Some people need treatment for an underlying condition such as a blood clot, heart problem or inflammatory disease.

When is surgery considered?

Surgery is only needed in a small number of cases — for example, if bleeding cannot be controlled in other ways, or if a growth or damaged part of the lung needs to be removed. Most people who cough up blood never need an operation.

Living with this condition

Most people who cough up blood recover well once the cause is treated. In the meantime, it is sensible to take it a little easier, keep your home smoke-free, and have a plan for what to do if the bleeding happens again — including knowing your local emergency number. If you have a long-term lung condition, your care team can help you manage flare-ups and recognise early warning signs.

Lifestyle tips

• Stop smoking, and avoid second-hand smoke and smoky places
• Keep rooms well ventilated and avoid inhaling strong fumes or dust
• Wash your hands often, especially during cold and flu season
• Keep up with any recommended vaccinations
• Pace yourself and rest when your body asks for it
• Tell your dentist and any other health professional that you have had bleeding, if relevant to your care

Diet and exercise

There is no special diet that stops coughing up blood, but eating well and drinking enough fluids helps your body recover and keeps phlegm easier to clear. Gentle activity, such as short walks, is usually fine and good for your lungs and mood. If you feel breathless or dizzy, stop and rest, and build up slowly. Ask your doctor before starting intense exercise if you are still being investigated.

Mental health and emotional wellbeing

Seeing blood come from your own body is genuinely frightening, and it is very common to feel anxious afterwards. Some people find themselves listening to every cough or worrying each night about it happening again. These feelings are normal and they usually settle once you have answers. If worry is affecting your sleep, work or mood, please tell your doctor — support is available and it helps. If you ever feel you cannot cope, contact your local emergency number or a crisis support service in your country straight away.

Prevention

You cannot prevent every cause of coughing up blood, but you can lower your risk. Not smoking — or stopping if you do — is the most important step. Treating chest infections early, keeping long-term lung conditions well managed, and getting recommended vaccinations all help protect your lungs.

Vaccines

Vaccines help prevent some of the infections that can cause you to cough up blood. Depending on your age, health and where you live, your doctor may recommend vaccination against flu, pneumonia, COVID-19 and whooping cough. Ask your doctor or pharmacist which ones are right for you.

Screening programmes

Some countries offer lung cancer screening for people at higher risk, usually people in a certain age range who smoke or used to smoke. Availability varies widely. If you smoke or used to smoke, ask your doctor whether a screening programme applies to you.

Complications

If left untreated

• Losing enough blood to cause anaemia (low iron in the blood), which brings tiredness and breathlessness
• Blood blocking part of the airway, making it harder to breathe
• Low oxygen levels in the body, which can affect the heart and brain
• A serious drop in blood pressure if bleeding is heavy, which is a medical emergency
• An infection spreading or getting worse if it is not treated
• Ongoing worry and disrupted sleep while the cause remains unknown

Long-term outlook

The outlook is good for most people. The great majority of cases are caused by infections or other treatable conditions, and people recover fully once the cause is found and managed. Even when the cause is more serious, early checks give you the best chance of effective treatment. Try to take it one step at a time, ask for the support you need, and remember that getting checked early is a positive step, not a reason to panic.

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