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Coughing up blood, known medically as hemoptysis, can be a truly unsettling experience. Though pop culture has instilled the idea that coughing up blood is a sign of a deadly disease, this is not always the case. Many of the causes of hemoptysis are relatively minor and quite common. This also means that it can be simple to treat or even prevent. However, hemoptysis can sometimes be a sign of a major medical problem, like lung cancer, so being knowledgeable is key.

The Background Mechanisms

Hemoptysis frequently occurs from the blood vessels in the lungs, bronchi, larynx, or trachea. Basically, it is bleeding of the airways. As blood travels through the blood vessels, they can be under varying levels of pressure. Because some of the blood vessels are quite thin, they can leak due to infection, inflammation, or trauma—eventually, the affected individual coughs up the blood.

Sore throat and cough, man with lung pain at home, health problems concept

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Bronchitis

The bronchi are tubes that carry air to the lungs. Bronchitis is swelling and irritation of these tubes, causing an overproduction of mucus. This leads to a persistent cough that can last for several weeks. Depending on the severity of the illness, underlying issues, and the cause, one of the potential symptoms of bronchitis is coughing up blood.

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Asthma

Other than acute infections, asthma is the leading cause of hemoptysis outside of a hospital setting. Asthma is a condition in which the airways swell and constrict, potentially producing extra mucus. Typical symptoms of asthma include chest tightness, shortness of breath, and frequent coughing attacks. Frequent and intense coughing may irritate the throat, causing bleeding that the individual then coughs up.

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Pneumonia

Within a hospital, pneumonia is one of the most frequent culprits behind hemoptysis. Pneumonia can be viral, bacterial, or fungal, depending on the cause. It, like many respiratory problems, can negatively impact breathing. Fluid or pus may build up in the lungs, and the affected person will often have a persistent cough full of yellow, green, or bloody mucus.

Photomicrograph of viral pneumonia, revealing inflammation and cellular damage caused by a viral respiratory infection

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Lung Cancer

Of the typical hemoptysis causes, one of the most serious is lung cancer. Occasionally, coughing up blood is one of the first signs that a person has lung cancer. It is also a much more common symptom than most people think. Some studies estimate that roughly 20% of people with lung cancer will experience hemoptysis.

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Rare Causes

Beyond the usual suspects, a number of conditions and issues can cause hemoptysis. Physical trauma, such as choking or inhaling a foreign body, may damage the blood vessels in the throat. Frequent anticoagulant use may also increase the risk of coughing up blood. Abscesses, tumors, and other growths can irritate the airways or outright leak blood.

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Severe Hemoptysis

The vast majority of cases of hemoptysis involve blood-tinged mucus or a small amount of actual blood. Hemoptysis usually counts as severe or "massive" if it exceeds 200 ml—slightly under a cup—within 24 hours. Fatality rates of severe hemoptysis vary dramatically from study to study, though the most accurate number is likely close to 9%.

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Differential Diagnoses

Hemoptysis must specifically originate from somewhere in the airways. However, blood-filled mucus from the sinuses or nose can sometimes resemble hemoptysis if it travels into the throat. These symptoms can be a sign of an infection or something more serious like sinus cancer. Additionally, extensive injuries or serious cardiac issues can also cause a person to cough up blood.

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Potential Treatments

Treatment of hemoptysis depends on the underlying cause. If the bleeding itself needs addressing, doctors may use iced saline and topical vasoconstrictors. Surgeons may use lasers to stop bleeding during procedures. One of the first treatments for bronchial bleeding is embolization, which is essentially creating an intentional blockage to limit bleeding. While it may be tempting to use cough suppressants, evidence suggests that doing so increases the risk of choking.

Middle age african american woman wearing casual clothes feeling unwell and coughing as symptom for cold or bronchitis

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When to See a Doctor

Most experts agree that people should speak with a doctor regardless of the potential cause of hemoptysis. While the vast majority of cases stem from minor or manageable causes, the risk of the culprit being something more dangerous is still present. Some red flags that indicate the hemoptysis originates from a serious issue include:

  • Massive or severe hemoptysis
  • Weight loss or fatigue
  • Back pain
  • History of smoking
  • Difficulty breathing while at rest

Tablet in hands, lung xray and healthcare, analysis and radiology with doctor and patient at hospital

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Disclaimer

This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.

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