This symptom is usually due to a problem within the airways or lungs.
Coughing up blood (hemoptysis) or blood in sputum should always be treated as a warning sign. The medical word for coughing up blood is hemoptysis.
Although it can be a sign of something sinister, it can also be due to something very common and treatable like a chest infection.
Common causes of coughing up blood
In 70-90% of cases, coughing up blood is due to infections such as bronchitis, pneumonia, and tuberculosis. In children, an inhaled foreign body (such as a small toy) could also be the cause of a bloody cough.
Although this symptom is scary, there are many explanations for coughing up blood, ranging from severe to less life threatening. In all cases, one should be examined by a doctor, as it can also indicate more serious, less common causes, such as:
According to the UK National Health Service, coughing up blood or hemoptysis, as it is known medically, is rarely a sign of a serious health problem. The usual culprit for bloody sputum is a severe cough.
In these cases, the symptom is not life threatening and simply a side effect of overworked and swollen airways.
Although anyone can get a chest infection, the very young and old, as well as those who are already ill or who smoke, are at the highest risk.
If there is a chest infection at the root of the bloody phlegm, you may notice that the phlegm is also mixed with pus.
Along with its many unhealthy side effects, smoking too much can also make you cough up blood. This is because smoking can damage the tissues of your respiratory system. The symptom usually goes away once you stop smoking.
Also known as altitude sickness or high-altitude pulmonary edema, this disease affects climbers, especially those who climb fast, and those who travel to high altitudes, for example, 8000 feet.
Height may be another explanation for a sudden red cough. The higher the altitude, the less oxygen and air pressure are in the atmosphere.
As a result, your body may have trouble adapting to the sudden change in the environment, and especially those who also exert themselves at higher altitudes, such as hikers and skiers, may feel the effects of something known as acute mountain sickness.
In addition to coughing up blood , acute mountain sickness can also cause symptoms such as: shortness of breath, tightness in the chest, and an inability to walk in a straight line or walk at all.
Mild cases of the condition can usually be remedied by reducing physical activity and returning to a lower altitude, but more severe cases may require hospitalization.
Medications and drugs
Coughing up blood can also be a side effect of blood-thinning medications that work to prevent the blood from clotting, and as a result, it can cause excessive bleeding.
Although, once again, coughing up blood while taking blood thinners is not an immediate sign of danger, it should not be ruled out and patients are advised to inform their physicians at the first sign of this symptom.
Many illegal drugs, especially those that are snorted or smoked, such as crack cocaine, can also cause bloody saliva. This is because these medications can damage the respiratory system, making them more likely to bleed.
Infection of the airways (bronchi), called acute bronchitis, and infection of the lung tissue, called pneumonia , are perhaps the most common causes of mild episodes of coughing up blood.
Chest infections can be caused by a virus or bacteria, and they usually go away on their own.
However, infection anywhere in the airways can cause hemoptysis. Typically, the blood is mixed with saliva (sputum). In addition, other symptoms related to the infection, such as a high fever and cough, will usually be present.
Hemoptysis usually occurs when the infection clears. Often no further tests are needed if the hemoptysis is clearly related to the infection and then clears up.
Pulmonary tuberculosis (TB) infection used to be a very common cause of hemoptysis. However, tuberculosis is now rare in the UK.
Most lung cancers arise from cells that line the bronchial tubes. One of the first symptoms of lung cancer can be coughing up blood or blood-stained sputum.
This may even be the first symptom before other symptoms develop. Most lung cancers develop in people over the age of 50, most commonly in smokers.
However, sometimes unusual types of lung cancer can affect younger people who don’t smoke. It occurs in young adults.
And it is almost as common in women as it is in men. Unfortunately, the average time between the onset of symptoms and the diagnosis of lung cancer is 12 months, a time during which treatment can often make a difference in the outcome of the disease.
Various other symptoms generally develop as well.
You can also cough up some blood from abnormal inflamed airways. This is typically just small amounts of blood from time to time. Occasionally, a large amount of blood can be expelled.
Inhaled and injured objects (trauma)
Inhaled objects can damage the airways and cause hemoptysis. For example, an inhaled peanut or small toy can sometimes be a cause in young children. Other types of injuries to a lung or airway can cause hemoptysis.
A pulmonary embolism
A pulmonary embolism is a serious and life-threatening condition. It is due to a blockage in a blood vessel in the lungs. The main symptoms are usually chest pain and dyspnea , but hemoptysis may also be present.
Heart and blood vessel problems
Severe heart failure can cause fluid to build up in the lungs. The main symptom is usually shortness of breath, but sputum may become frothy and bloodstained.
Pulmonary edema is the abnormal accumulation of fluid in the alveoli of the lungs due to conditions such as congestive heart failure, kidney failure , major injury, lung damage from infection or poison gas, and even high altitudes.
Heart conditions such as ventricular systolic heart failure, mitral stenosis, or a blood clot in the pulmonary artery (pulmonary embolism) can cause a person to cough up blood.
However, these are rare causes of hemoptysis, although hemoptysis is the recognized symptom of pulmonary embolism. Several rare blood vessel problems can also cause bleeding in the lungs or airways.
Swelling and abnormal tissue deposits
There are a number of conditions that can cause inflammation or produce abnormal tissue deposits in various parts of the body. Sometimes these conditions affect the lung tissue or the airways.
Inflamed or abnormal tissue in the airways or lungs can bleed from time to time and cause hemoptysis. Conditions that can cause this include:
Goodpasture’s syndrome, pulmonary hemosiderosis, Wegener’s granulomatosis, lupus pneumonitis, pulmonary endometriosis, and broncholithiasis.
Note : These conditions are very rare and you would normally have symptoms other than hemoptysis.
Pulmonary veno-occlusive disease
This is a rare disease that occurs in children and young adults characterized by high blood pressure in the pulmonary arteries connected to the right side of the heart.
Although the cause is not exactly known, viral infection or complications from chemotherapy, bone marrow transplantation, and blood cancer are believed to be responsible for this disorder.
Lupus or systemic lupus erythematosus is an autoimmune disease in which the body’s immune system attacks the healthy tissues of any organ, including the lungs. This disease is more common in women than in men, especially African Americans and Asians.
No cause identified
Despite testing, no cause can be found in about one in eight people with hemoptysis. This is called idiopathic hemoptysis.
So in some people, the cause of the bleeding remains a mystery. Perhaps in these cases it is just a small blood vessel that bursts and bleeds for a while, a bit like a nosebleed.
However, never assume that a cause will not be found. Always see a doctor if you cough up blood and the cause is unknown. The diagnosis of idiopathic hemoptysis can only be made once other more serious causes can be ruled out.
Different ways and symptoms coughing up blood can occur
Coughing up blood can present itself in different ways. It can be streaked, frothy, or frank (pure) blood.
1. Striped (blood lines in phlegm)
Other symptoms can occur at the same time as coughing up blood. For example, cough, chest pain, dyspnea, high fever, malaise, wheezing, or other lung symptoms.
The presence and type of other symptoms can help pinpoint a cause for the bleeding. Sometimes there are no other symptoms at first.
Infections like bronchitis and pneumonia present themselves this way. If it persists and is associated with weight loss and night sweats, it may be due to tuberculosis.
Tuberculosis (TB) is highly prevalent in South Africa and is a common cause of coughing up blood. If you experience weight loss, night sweats, and a persistent cough, get tested for tuberculosis.
Remember, you can get TB anywhere, even while on the train or shopping, as it is spread through the cough drops of an infected person.
2. Pink and frothy sputum
Blood is often mixed with saliva (sputum). This is common. Sometimes there is a small amount of blood mixed with sputum each time you cough. Sometimes it is a single small amount of blood.
This is highly suggestive of fluid overload in the lungs (pulmonary edema). This can be due to heart failure (such as after a heart attack) or kidney failure.
However, if you ever cough up blood and you don’t know why, no matter how small the amount of blood is, you should see your doctor soon. Coughing up blood is a symptom that can indicate a serious illness.
As a general rule of thumb, the earlier a serious problem is diagnosed, the better the chances that treatment can improve the prognosis.
Considered an emergency, coughing up sparkling pink sputum should seek help immediately, as it can be life threatening.
3. Frank blood (pure)
Coughing up what looks like pure blood is a worrisome sign. It can be classified as follows:
This is an emergency, especially if the bleeding won’t stop and you are losing a lot of blood. You must call an ambulance urgently. However, this situation is very rare.
The volumes are only guides; investigators do not accept precise volume definitions and cases must be individualized.
Minor : less than 5 ml in 24 hours. This is generally caused by tuberculosis, severe infections, and cancers.
Massive : more than 2 cups in 24 hours or more than half a cup per hour, or more than 50 ml at a time. This may be due to a cancer that, due to its continued growth, ruptured through a blood vessel.
When tuberculosis caused large cavities in the lung, the blood vessels can also be damaged, causing very significant bleeding.
When is coughing up blood dangerous?
- In the case of massive amounts of blood.
- When coughing up blood is associated with back or chest pain.
- If you notice weight loss or fatigue.
- When you have a strong history of smoking.
- When you have trouble breathing (even at rest).
There are several causes for coughing up blood (hemoptysis). If you cough up a lot of blood, call an ambulance right away. If you cough up small amounts of blood, see your doctor as soon as possible if you don’t know the cause.
This is because sometimes a serious condition like lung cancer can be the cause. As a general rule of thumb, the earlier a serious problem is diagnosed, the better the chances that treatment can improve the prognosis.
How do you know if someone is coughing up blood or vomiting blood?
It is very important to distinguish between coughing up blood and vomiting blood. When you cough up blood, the blood comes from the respiratory system, while vomiting blood indicates bleeding from the stomach or esophagus or even the intestines.
When you notice blood when coughing, it would be best to speak with your doctor.
When to see a doctor
The most common reason for coughing up blood is acute bronchitis, a sign of a serious medical condition. Call your doctor if you have any of these symptoms:
Blood in mucus that lasts more than a week, is severe or worse, or comes and goes over time.
- Chest pain.
- Sweat at night
- Fever higher than 101 degrees.
- Shortness of breath with your usual activity level.
People who require treatment for coughing up blood are almost always treated in a hospital, until the cause is identified and the threat of serious bleeding passes.
What evaluation and tests can be done?
In people who cough up blood, tests are focused on determining the rate of bleeding and any risks to breathing. The cause of the hemoptysis must be identified. Tests for coughing up blood include:
If you are actively bleeding, a CT scan is generally the imaging test of choice to assess the bleeding.
Most airway bleeds come from the bronchial arteries, and bronchial artery embolization (essentially placing a clot in the artery) is often an effective treatment.
If your doctor suspects you may have lung cancer, you can learn more about how lung cancer is diagnosed, what to expect, and your potential risk factors for lung cancer (it goes beyond smoking and at least one of each five women developing lung cancer have not smoked a single cigarette).
Don’t rule out the possibility that you may have lung cancer until the diagnosis has been ruled out.
Treatment depends on the underlying cause. Treatments include ice-cold saline and topical vasoconstrictors such as epinephrine or vasopressin. Selective bronchial intubation can be used to collapse the lung that is bleeding.
In addition, endobronchial tamponade can be used. Laser photocoagulation can be used to stop bleeding during bronchoscopy. Angiography of the bronchial arteries can be done to locate the bleeding and can often be embolized.
Non-small cell lung cancer can also be treated with erlotinib or gefitinib. Cough suppressants can increase the risk of choking.
Surgery : The surgical option is usually the last resort for coughing up blood, if it is severe and life-threatening, it may require surgery to remove a lobe of the lung or remove the entire lung (pneumonectomy).
Treatments for hemoptysis must also address the underlying reason for coughing up blood. Other treatments for people who cough up blood may include:
- Antibiotics for pneumonia or tuberculosis.
- Chemotherapy and / or radiation for lung cancer.
- Steroids for inflammatory conditions.
People with excessively thin blood due to the use of medications may require transfusion of blood products or other medications to reduce blood loss.
Blood-tinged sputum can sometimes be a symptom of an underlying condition that is unavoidable, but methods are available to help prevent some cases. The first line of prevention is taking steps to avoid the respiratory infections that are likely to cause it.
You can do the following to prevent blood-stained sputum:
Stop smoking if you smoke. Smoking causes irritation and inflammation and also increases the likelihood of serious illness.
If you feel like you are getting a respiratory infection, drink more water. Drinking water can thin phlegm and help flush it out.
Keep your home clean because the dust is easy to breathe in, and it can irritate your lungs and make your symptoms worse if you have chronic obstructive pulmonary disease, asthma, or a lung infection.
Mold can also cause respiratory infections and irritation, which can lead to bloody sputum.
Coughing up yellow and green phlegm can be a sign of a respiratory infection. See your doctor for early treatment to help prevent complications or a worsening of symptoms later.
Coughing up blood in children tends to have different causes than the same symptom in adults. The most common causes are infections, such as pneumonia, bronchitis, and tuberculosis.
About a third of the time a cause cannot be determined and the symptom goes away without finding a cause. About six percent of children with hemoptysis have been found to have underlying heart disease, and in about four percent, cancer has been found to be the cause.
Coughing up blood can be a scary symptom, as the causes can be as mild as irritation of the airways from coughing or as serious as lung cancer or a blood clot in the lungs.
Even small amounts of bleeding in the lungs can be dangerous, due to the risk of aspiration (and suffocation). Coughing up just a teaspoon of blood is considered a medical emergency.
Although scary, even with active bleeding, a lot can be done. Bronchial artery embolization is often very effective in what could otherwise be a life-threatening situation.
While coughing up blood is the first symptom in only 7 percent of lung cancers, it is important to rule out this possibility in adults, regardless of risk factors.
As with other cancers, the earlier lung cancer is diagnosed, the better the chance of a cure.