Why Am I Coughing Up Blood?

Call 911 if you cough up more than a few teaspoons of blood

Table of Contents
View All
Table of Contents

Coughing up blood (hemoptysis) can be a sign of many different things, including a chest infection like pneumonia, a chronic lung disease like COPD, a traumatic chest injury, or even a cardiovascular condition. In rare cases, coughing up blood or blood in mucus (phlegm) may be a sign of lung cancer.

If you have been coughing up blood, your healthcare provider will want to pinpoint the source of the bleeding, whether it be from the pharynx (throat), larynx (voice box), trachea (windpipe), bronchi (the main airways in the lungs), or the lungs themselves. Coughing up more than a few teaspoons of blood warrants an immediate visit to the emergency room.

This article looks at the possible causes of hemoptysis as well as how the condition is diagnosed and treated. It also describes when coughing up blood is a medical emergency and what the risk of death is from massive hemoptysis.

Coughing up blood causes

Verywell / Nusha Ashjaee

What Causes You to Cough Up Blood?

There are many different reasons why you may be coughing up blood, and there is usually no way to tell by just looking at it. Coughing up blood in any amount should be taken seriously.

Lung-related causes of hemoptysis include:

Traumatic causes of hemoptysis include:

Cardiovascular causes of hemoptysis include:

Other causes of hemoptysis include:

Hemoptysis as a Sign of Lung Cancer

Though lung cancer is one of the less likely causes of hemoptysis, hemoptysis is the first sign of the disease in 7% to 35% of people diagnosed with lung cancer.

Causes in Children

Coughing up blood in children tends to have different causes than in adults. The most common causes are respiratory infections, such as pneumonia, bronchitis, and tuberculosis. Underlying heart disease is the second most common cause in children.

Roughly one-third of hemoptysis cases in children are idiopathic (meaning of unknown origin) with symptoms resolving without ever determining the cause.

Symptoms of Hemoptysis

The symptoms of hemoptysis can vary by the underlying cause, the location of the bleeding, and the severity of the bleeding.

If you have hemoptysis, you may experience symptoms like:

  • Splattered blood as you cough
  • Blood-streaked or frothy pink mucus
  • Bloody gelatinous clumps
  • Pus-like blobs
  • Chest pain
  • Fever

Hemoptysis vs. Hematemesis

By definition, hemoptysis refers to bleeding that arises from the respiratory tract. This differs from hematemesis, or the vomiting of blood, which arises from the digestive tract.

With hemoptysis, the blood is generally bright red or rust-colored and may be frothy and mixed with phlegm. With hematemesis, the blood will be dark red or brown and/or look like coffee grounds.

When to Go to the Hospital

Coughing up blood can quickly become an emergency. Coughing up more than a few teaspoons of blood is considered a medical emergency.

Coughing up 100 cubic centimeters (cc) of blood—or roughly 1/3 of a cup—is called massive hemoptysis and is associated with a high risk of death.

If coughing up large amounts of blood, do not drive yourself to the hospital or have someone else drive you—call 911. Coughing up blood in these volumes can quickly cause airway obstruction and unconsciousness before you have the chance to reach the hospital.

When to Call 911

Call 911 if you experience chest pain, shortness of breath, or lightheadedness while coughing up even trace amounts of blood. Unlike bleeding in other parts of the body, coughing up even a small amount of blood can rapidly flood the airways, leading to choking, asphyxiation, and even death.

Testing for Causes of Hemoptysis

If you cough up blood—even a very small amount—it is important to see your healthcare provider. If possible, bring a sample of what you have been coughing up to your appointment. Wrapping the sample in plastic wrap can preserve it better than wrapping it in tissue.

The diagnosis will involve a review of your medical history and a physical exam. The healthcare provider will examine your mouth and throat and also listen for lung sounds using a stethoscope.

Based on the findings, your healthcare provider will recommend tests to help determine the cause. These may include:

If you are actively bleeding, a CT scan is usually the imaging test of choice.

A timely diagnosis is essential when you have hemoptysis. While the cause may ultimately be benign (not harmful) or treatable, an early diagnosis almost invariably leads to better outcomes irrespective of the cause.

Such is the case with lung cancer in which the average time between the appearance of symptoms and the initial diagnosis is 12 months. Given that hemoptysis is one of the early tell-tale signs of lung cancer, ignoring the sign may rob you of the chance for an early diagnosis.

How Is Hemoptysis Treated?

While it is important to find the underlying cause of hemoptysis, the symptom sometimes needs to be treated immediately even if the cause is not entirely clear. In emergencies, this may involve:

  • Vasoconstrictors: There are drugs such as vasopressin that can prevent severe drops in blood pressure that can lead to shock.
  • Intravenous fluids: Fluids delivered through a vein in your arm may be given if you have signs of (or are at risk of) hypovolemic shock caused by the excessive loss of blood.
  • Intubation: The insertion of a breathing tube may be necessary to avoid choking and asphyxiation, especially with massive bleeding.
  • Blood transfusion: This may be essential if there is evidence of massive blood loss.

Once you are stabilized, effort will be made to stop the source of the bleeding wherever it is. There are several ways this may be done:

Bronchoscopy

Bronchoscopy involves the use of a flexible scope (called a bronchoscope) into your mouth to examine the respiratory tract. The scope can also be equipped with specialized tools that help stem the bleeding. Bronchoscopy procedures are most effective when the bleeding is mild to moderate.

Options include:

  • Endobronchial insertions: These are substances that are delivered through the bronchoscope to stop bleeding, such as iced saline, cellulose, and an organic fiber known as fibrinogen.
  • Argon photocoagulation: This is a technique used to form blood clots locally.
  • Electrocautery: This involves electricity to burn tissues to stop a bleed.
  • Endobronchial stent placement: This involves the insertion of a tube into blood vessels to redirect circulation after the bleeding has been stopped.

Bronchial Artery Embolization

When the bleeding is massive, bronchial artery embolization is typically the first-line treatment. In this procedure, a tube called a catheter is inserted into an artery in the upper thigh and threaded to the lung to the site of the bleeding.

Once in place, various substances are injected through the catheter to embolize (create a clot) in the artery. Options include a gelatin sponge, PVC particles, or a metallic coil.

Surgery

Surgery is needed less often in the past for hemoptysis but may still be used in situations where there is massive hemoptysis due to trauma.

This may include a type of surgery called a wedge resection in which a wedge of lung tissue is removed and the cut ends are sewn together. This may be performed with traditional open surgery or minimally invasive video-assisted thoracoscopic surgery.

Outlook

Generally speaking, the prognosis (outlook) is good if a person has mild to moderate hemoptysis—meaning far below the "danger zone" of 1 teaspoon. If the bleeding is controlled without an acute respiratory event, the symptom will cease. This doesn't mean the underlying cause is cured; more treatment may be needed.

On the other hand, massive hemoptysis is associated with a mortality (death) rate of over 50%. In such cases, death is caused not by the loss of blood but rather by the flooding of the lungs with blood, leading to asphyxiation and cardiovascular collapse.

With cardiovascular collapse, the drop in blood flow to the brain causes unconsciousness and the onset of heart rhythm problems, heart valve or heart muscle dysfunction, and eventually cardiac arrest. Even with appropriate emergency care, the risk of death is high.

Summary

Coughing up blood (hemoptysis) can be caused by many different things, from violent coughing and chronic lung disease to respiratory infection and lung cancer. There is no way to tell what is involved without an evaluation by a healthcare provider.

Coughing up any amount of blood warrants a medical visit, but coughing up more than a teaspoon is considered a medical emergency. Massive hemoptysis (coughing up a 1/3 cup of blood or more) carries a high risk of death.

The treatment of hemoptysis may involve vasodilator drugs and intubation as well as clotting agents or electrocautery to help seal the ruptured vessel. Surgery may be needed in cases of trauma.

Frequently Asked Questions

  • Is coughing up blood a sign of COVID?

    Not typically. In rare instances, people do cough up blood. According to some reports, fewer than 1% to 5% of people admitted to the hospital for COVID suffer from this symptom. It has also been seen in people recovering from COVID-related pneumonia.

  • What medications cause you to cough up blood?

    Blood thinners, also known as anticoagulants, can sometimes cause you to cough up blood. These medications include Coumadin (warfarin), Xarelto (rivaroxaban), and Pradaxa (dabigatran). Call your doctor immediately if you experience this.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Walter FM, Rubin G, Bankhead C, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer. 2015;112 Suppl 1:S6-13. doi:10.1038/bjc.2015.30

  2. Earwood JS, Thompson TD. Hemoptysis: evaluation and management. Am Fam Physician. 2015;91(4):243-249.

  3. Gershman E, Guthrie R, Swiatek, Shoajee S. Management of hemoptysis in patients with lung cancer. Ann Transl Med. 2019 Aug;7(15):358. doi:10.21037/atm.2019.04.91

  4. Simon DR, Aronoff SC, Del vecchio MT. Etiologies of hemoptysis in children: a systematic review of 171 patients. Pediatr Pulmonol. 2017;52(2):255-259. doi:10.1002/ppul.23497

  5. Aslan A, Sismanlar T. Hemoptysis in children: sometimes scary sometimes petty. Eur Respir J. 2015;46 (suppl 59):PA1239. doi:10.1183/13993003.congress-2015.PA1239

  6. Laine L, Laursen SB, Zakko L, Dalton HR, Ngu JH, Schultz M, Stanley AJ. Severity and outcomes of upper gastrointestinal bleeding with bloody vs. coffee-grounds hematemesisAm J Gastroenterol. 2018 Mar;113(3):358-366. doi:10.1038/ajg.2018.5

  7. MedlinePlus. Coughing up blood.

  8. Davidson K, Shojaee S. Managing massive hemoptysis. Chest. 2020 Jan;157(1):77-88. doi:10.1016/j.chest.2019.07.012

  9. Lanci AR, Franchi P, Occhipinti M, et al. Diagnosis and management of hemoptysis. Diagn Interv Radiol. 2014 Jul-Aug;20(4): 299–309. doi:10.5152/dir.2014.13426

  10. Del Ciello A, Franchi P, Contegiacomo A, Cicchetti G, Bonomo L, Larici AR. Missed lung cancer: when, where, and why? Diagn Interv Radiol. 2017;23(2):118-126. doi:10.5152/dir.2016.16187

  11. Cody O'Dell M, Gill AE, Hawkins CM. Bronchial artery embolization for the treatment of acute hemoptysis. Technique Vascular Intervention Radiol. 2017;20(4):263-265. doi:10.1053/j.tvir.2017.10.006

  12. Yun JS, Song SY, Na KJ, et al. Surgery for hemoptysis in patients with benign lung disease. J Thorac Dis. 2018 Jun;10(6):3532–3538. doi:10.21037/jtd.2018.05.122

  13. Sato L, Kinoshita N, Nakamoto T, Ohmagari N. Hemoptysis and a newly formed lung bulla in a case of convalescent COVID-19 pneumonia. Intern Med. 2021;60(5):803-805. doi:10.2169/internalmedicine.5684-20

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."