Definition and Overview

Hemoptysis is a medical term that means coughing up blood from the respiratory tract. It commonly occurs due to bronchitis.

Bronchitis refers to the inflammation of the bronchial tubes. These are the tubes that carry air to and from the lungs. The condition causes patients to cough up thickened mucous. It can be acute or chronic. Acute cases are often caused by respiratory infections or a cold. Patients with this condition often get well within a week or two without any lasting health problems. Chronic cases, on the other hand, are often caused by smoking. This causes the bronchial tubes to become inflamed. In many cases, this causes them to bleed. Chronic bronchitis is one type of chronic obstructive pulmonary disease (COPD). COPD is an umbrella term that refers to a number of progressive lung diseases marked by breathlessness.

It is important to note that coughing up blood can also be caused by conditions not related to the respiratory tract. For example, patients with problems in the gastrointestinal (GI) tract can vomit blood from the stomach. Some people also suffer from severe nosebleeds. In some cases, the blood drains into the windpipe.

Causes of Condition

Aside from bronchitis, coughing up blood can also be caused by the following:

  • Bronchiectasis - A condition marked by damaged, thickened, or widened bronchial tubes. It can block the airways and cause chronic infections.

  • Congestive heart failure - Also known as CHF, this condition affects the function of the heart. It prevents the organ from pumping blood properly. This slows down blood circulation throughout the body. The condition can cause fluid to build up in the lungs. This can result in persistent coughing and wheezing.

  • Illegal drugs - An example is crack cocaine. This damages the respiratory system and causes bleeding.

  • Inflammatory or autoimmune conditions - An example is lupus. This disorder can attack the lining and the blood vessels of the lungs, causing them to bleed.

  • Lung cancer - Hemoptysis is one of the most common symptoms of lung cancer. It is seen in over 20% of patients.

  • Pneumonia - This refers to infection of one or both lungs. It can cause inflammation in the air sacs.

  • Tuberculosis - This condition attacks different parts of the body, most commonly the lungs.

Other possible causes are pulmonary embolism, parasitic infection, and mitral valve stenosis. Abnormalities in the blood vessels of the lungs can also cause the condition.

Key Symptoms

Hemoptysis is not a disease or disorder in itself. It is a symptom of many conditions that cause damage to the respiratory tract. If caused by bronchitis, patients may also present with fatigue, chest discomfort, and fever. Other symptoms include the production of mucous and shortness of breath.

Who to See and Treatment Available

Treatment of hemoptysis depends on the severity and cause of the condition. If caused by acute bronchitis, treatment is often not needed. The condition often gets better on its own between one and two weeks. However, patients are advised to consult a doctor if the condition is getting worse or not improving within the said time frame.

To determine what causes a patient to cough up blood, the following tests and procedures are used:

  • Standard tests - These include a physical exam and review of the patient’s medical history. These also include blood and urine tests as well as a blood chemistry profile.

  • Imaging tests - Doctors obtain images of the lungs using a chest x-ray and a CT scan. The images produced by these tests can show if any part of the respiratory tract is inflamed or bleeding.

  • Bronchoscopy - This is a standard test used to determine what causes symptoms like an infection and a persistent cough. It is also used to confirm any abnormalities detected by standard and imaging tests. If needed, it can also be used to obtain samples of lung tissue or mucous for further study. There are two types of bronchoscopy - flexible and rigid. Patients who are coughing blood undergo the latter. The procedure is performed under general anaesthesia.

The goals of treatment are to stop bleeding and treat the underlying condition. Patients may be given antibiotics or steroids if the condition is caused by an infection or autoimmune disorders. Patients with tumours may need to undergo surgery to have the abnormal growth removed. They may also have the option to undergo chemotherapy or radiation therapy.

Treatment options also include the use of medications that narrow or constrict the blood vessels to slow or block blood flow. Doctors may also block the bleeding artery using metal coils. This procedure involves advancing a catheter into the artery that supplies blood to the lungs. Once there, a dye is injected through the catheter. The patient then undergoes an x-ray. The image will show which artery is bleeding.

In most severe cases, doctors may suggest the removal of the affected lung. People can survive with one lung. Following the operation to remove the diseased lung, the remaining lung will inflate and take up some of the extra space. Once recovered from surgery, the patient can expect to restore at least 70% of his or her respiratory function. However, they may be advised against certain strenuous activities.

References:

  • Ferri FF. Hemoptysis. In: Ferri’s Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015:543. https://www.clinicalkey.com.

  • Uppsala Academic Hospital > Guidelines for treatment of acute lung diseases. August 2004. Authors: Christer Hanson, Carl-Axel Karlsson, Mary Kämpe, Kristina Lamberg, Eva Lindberg, Lavinia Machado Boman, Gunnemar Stålenheim

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