Coughing up blood, otherwise known as hemoptysis, can be very frightening. It can also be confusing at first. Is the blood truly coming from your lungs, or could it be from a nosebleed, your esophagus, or from your stomach?
This symptom may occur when there is bleeding in the throat, or in the large or small airways of the lungs. Many people describe their symptom as spitting up blood streaked mucus. Blood that is coughed up is often mixed with phlegm and can have a bubbly appearance.
If you cough up blood it doesn’t necessarily mean you have lung cancer. There are many conditions that can cause this symptom, and only one of these is lung cancer. But since the outlook for lung cancer is better the earlier it's diagnosed, it is important to consult your doctor as soon as possible.
It is important to make a distinction between coughing up blood (hemoptysis) and blood that is brought up through your mouth from other regions of your body. “Pseudohemoptysis” is a term that describes spitting up blood that doesn’t come from your lungs or bronchial tubes. Hematemesis is a term that refers to blood that comes from your esophagus and stomach (throwing up blood.)
Some Possible CausesThe most common causes of coughing up blood are irritation in the airways from coughing, or an infection. That said, hemoptysis is the only symptom in 7% of people diagnosed with lung cancer. Some possible causes of blood streaked sputum include:
- Inflammation and irritation in the airways from repeated coughing
- Lung Cancer
- Pulmonary edema
- Blood clots in the lungs (pulmonary embolus)
- Tuberculosis – Tuberculosis is the most common cause of coughing up blood worldwide, but less common in the United States
- Inhalation of a foreign body
- Bleeding Disorders – Bleeding disorders can be inherited, or due to medications or supplements that increase the time it takes for your blood to clot
When to See Your DoctorIf you cough up blood – even just once – it is important to make an appointment to see your physician. You should call your doctor immediately if you experience chest pain, shortness of breath, lightheadedness, or cough up more than a few teaspoons of blood. Coughing up more than a cup of blood in 24 hours is considered “massive hemoptysis” and is a medical emergency.
If possible, bringing a sample to your doctor’s appointment can be helpful. Wrapping the sample in plastic wrap or wax paper can preserve the sample better than wrapping it in tissue.
Questions Your Doctor May Ask You
- How long has this been happening?
- How much blood did you cough up? Was it mixed with mucus?
- What other symptoms have you been experiencing? For example, a persistent cough, allergy symptoms, shortness of breath, hoarseness, wheezing, unexplained weight loss, or fatigue.
- Have you had any episodes of choking?
- Do you, or have you ever, smoked?
- What medications are you taking (including any herbal supplements)?
- What other medical conditions do you have?
- Has anyone in your family had bronchitis, bleeding disorders, lung problems, or lung cancer?
EvaluationDepending upon the amount of blood you are coughing up, your doctor will first want to make sure your airway is okay to prevent aspiration (breathing in the contents that are present in your mouth), and control any active bleeding. He will then recommend tests to determine the cause. Possible tests may include:
- Lab tests to check your blood counts and look for any reason for bleeding
- A chest x-ray to look for infection of any evidence of a tumor
- A CT Scan of your chest
- Bronchoscopy – To check for foreign bodies or evaluate your airways for a tumor
TreatmentTreatment will depend upon the cause of your symptoms as well as the amount of blood you have been coughing up.
Bidwell, J. and R. Pachner. Hemoptysis: diagnosis and management. American Family Physician. 2005. 72(7):1253-60.
National Institute of Health. Medline Plus. Coughing up blood. Updated 05/01/11. http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm