Causes and General Management of Coughing Blood

Coughing up blood is also known as hemoptysis. The blood originates from either the lungs or the bronchial tubes (the airway connecting the lungs with the lower end of the trachea). Hemoptysis can range from just a mild red-colored staining of the coughed-up sputum to coughing up of fresh blood. The coughed up sputum or blood may contain blood clots also. Coughing up more than 200 ml of blood per day is usually considered massive hemoptysis which usually requires urgent medical and/or surgical intervention in an intensive care setting.

Causes of Coughing Up Blood

The most important causes of coughing blood in the adults are bronchitis, lung cancer, pneumonia and tuberculosis (rare in developed nations). However, in children, lower respiratory tract infections and aspiration of foreign body are the most common causes. The table given below mentions the most important causes of hemoptysis. 

Cause

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Tumors

Neoplasm in the lung or bronchial tree can cause hemoptysis. Hemoptysis in persons at risk (age > 40 yrs and/or smoker) requires thorough evaluation for presence of lung cancer.

Bronchitis

Both acute and chronic bronchitis (inflammation of the bronchi) can cause hemoptysis. It is one of the most common causes.

Pneumonia

It is inflammation of the lung tissue, often caused by infection. Pneumonia is also a common cause of hemoptysis.

Lung Abscess

Localized collection of pus in the lungs caused by infections is known as lung abscess.

Tuberculosis

This is the most important cause of hemoptysis in developing countries. In developed countries, tuberculosis is an unlikely cause for coughing up blood unless the person is immunocompromised (AIDS, anti-cancer therapy, etc.) or has history of travel to a developing nation.

Lung / Airway Trauma

Injury to lung (lung contusion) or the airways (bronchi, trachea) can cause coughing of blood.

Foreign Body in Airway

Foreign body in trachea or bronchus can cause hemoptysis. This is more common in children.

Bronchiectasis

Destruction of bronchus resulting in localized dilation of bronchial tree is known as bronchiectasis.

Pulmonary Embolism

Sudden blockage of the pulmonary artery or its branch by emboli is known as pulmonary embolism. It is a rare cause of hemoptysis.

Arteriovenous Malformations

AV malformations are abnormal connections between the veins and arteries. AV malformations in lung tissue can cause hemoptysis.

Pulmonary Aspergilloma

Mycetoma or pulmonary aspergilloma is a fungal infection (aspergillus species) that grows in a lung cavity.

Idiopathic

Many times no cause for the hemoptysis is found even after thorough evaluation. Such cases are referred to as idiopathic.

 

General Approach to Management of Hemoptysis

Stopping the coughing up of blood and prevention of aspiration is the immediate goal of management. Further treatment is focused on the cause of the hemoptysis.

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