Haemoptysis (coughing up blood)

Haemoptysis is the medical term for coughing up blood from your lungs or airways.

It can range from a small amount of blood-streaked sputum (phlegm, or mucus that you cough up) to a lot of blood.

Massive haemoptysis can be life-threatening. It can:

• block your airways
• cause your oxygen levels to drop too low
• lead to dangerous amounts of blood loss

Call an ambulance on triple zero (000) if you, or someone you know:

• is coughing up a lot of blood
• is coughing up blood and is also short of breath
• is vomiting blood

Haemoptysis is when you cough up blood that comes from your lungs or airways (the tubes that bring air to your lungs).

Haemoptysis is not the same as:

• having blood in your saliva due to bleeding in your mouth
• bleeding from your nose and throat
• vomiting blood

It can sometimes be hard to tell where the bleeding is coming from. If it is haemoptysis, it is likely that:

• the sputum (what you cough up) is frothy
• the blood is bright red

Depending on the cause of your haemoptysis, you might also have symptoms such as:

• fever
• cough
• night sweats
• weight loss
• fatigue
• difficulty breathing or shortness of breath
• chest pain

One of the most common causes of haemoptysis is an infection, such as:

• bronchitis
• pneumonia

If this is the case, you might also have a cough and fever.

Another common cause is bronchiectasis, a condition where the large airways in your lungs are damaged. In this case, you might have recurrent chest infections and a productive (wet) cough.

Other conditions that can cause haemoptysis are:

• chronic obstructive pulmonary disease (COPD)
• lung cancer
• tuberculosis
• pulmonary embolism — a blood clot in the arteries that supply blood to your lungs
• a lung abscess
• cystic fibrosis
• a bleeding disorder or problem with your blood vessels

Other causes of haemoptysis are:

• a lung injury, including from a recent medical procedure
• having something stuck in your airway
• a heart condition
• taking medicines that affect blood clotting

Sometimes, doctors cannot find the cause of haemoptysis.

If you are coughing up a lot of blood or also have symptoms such as chest pain or breathing problems, call triple zero (000) for an ambulance.

Even if you cough up just a small amount of blood, see a doctor as soon as possible.

Haemoptysis is managed according to the amount and rate of bleeding. If your condition is life-threatening, you will need urgent treatment before any tests are done.

To find out the cause of haemoptysis, your doctor will ask questions such as:

• How much blood are you coughing up?
• How many times have you coughed up blood?
• How long have you been coughing up blood?
• What other symptoms do you have?

You will probably be asked about:

• your current and past health conditions
• any medicines you are taking
• whether you smoke or have ever smoked

Your doctor will do a physical examination. They will:

• look for any signs of conditions that can cause you to cough up blood
• check your temperature
• look up your nose to make sure the bleeding is not from there

Your doctor may ask for a sample of sputum that you have coughed up. This can be tested in a lab to help work out the cause of your bleeding.

Depending on your condition, your doctor may recommend:

• blood tests
• a chest x-ray
• a CT scan
• a bronchoscopy — a procedure to see inside the airways in your lungs
• a ventilation-perfusion scan — which looks at both the air flow and blood flow in your lungs

The type of treatment will depend on:

• how much blood you are coughing up
• the cause of your bleeding

For example, if you have a bacterial infection, you will probably be treated with antibiotics.

If you have severe haemoptysis, you may need a surgical procedure to stop the bleeding. This will be done before the cause is found.

The Lung Foundation Australia (Opens in new tab) has information on lung conditions and offers support for people with lung disease — call 1800 654 301.

You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.