Hemoptysis: What You Need to Know About Coughing Up Blood

Medically Reviewed By Carissa Stephens, R.N., CCRN, CPN
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Hemoptysis, or coughing up blood, occurs when coughing produces blood or bloody mucus from the respiratory system. It can have a variety of causes, including inflammatory diseases, cancer, and irritation of the respiratory organs. A bloody cough can present as small amounts of red blood or frothy saliva or phlegm that has streaks of blood. Seeing blood after coughing can be concerning. However, some causes — such as mild chest infections — are easily treatable.

In approximately 1 in 5 cases of hemoptysis, no cause is evident. However, a doctor may diagnose a more serious underlying cause.

You should contact your doctor promptly if you have any symptoms of coughing up blood.

Read on for more information about the symptoms, causes, and treatments associated with hemoptysis.

What is coughing up blood?

Man coughs into tissue
Carol Yepes/Getty Images

Coughing up blood refers to the production of blood or bloody mucus from the respiratory tract when you cough. This system includes the lungs and bronchial tubes, which are the main airway passages.

The medical term for coughing up blood is “hemoptysis.” It is different from spitting up blood from the mouth, throat, or gastrointestinal system.

A bloody cough can vary in presentation and include coughing up a liquid that appears pink and frothy or coughing up bright or rust colored red fluid. The fluid produced from a cough can also have bloody streaks.

To diagnose hemoptysis, your doctor will need to determine where the blood is coming from and whether or not you are truly coughing up blood from the lungs.

Blood could appear to be coming from the respiratory tract but actually stem from another part of the body, such as the throat or nasal passages. For example, bleeding from the nose or mouth may make a cough appear bloody, while blood that is dark and contains food can come from the digestive system.

Causes of coughing up blood

Coughing up blood or bloody phlegm can have many causes. These can include irritation of an area in the respiratory tract, an inflammatory condition or infection, or an underlying respiratory disease.

Some causes may not present an immediate need for concern. In fact, one common cause of coughing up blood is a chest infection. Mild chest infections can improve without clinical treatment.

However, the complications of some respiratory conditions can become life threatening.

Possible causes of coughing up blood

Respiratory system diseases such as pneumonia and COVID-19 can cause you to cough up blood. They can be serious, and, in the case of pneumonia, symptoms can begin suddenly in as little as 24 hours.

Some common causes of hemoptysis can include:

Learn more about pneumonia here.

Some less common causes of coughing up blood include:

Some non-cardiopulmonary medical conditions can also lead to blood coming from the mouth and mimic coughing up blood.

What other symptoms might occur with coughing up blood?

You may experience other symptoms alongside coughing up blood, depending on the underlying cause. These symptoms can affect other bodily systems, such as the circulatory system and the digestive tract.

Coughing up blood may occur with other symptoms, including:

Some of the same causes of coughing up blood can also cause a wet or productive cough, which may or may not contain blood. For example, pneumonia may also lead to coughing up mucus or phlegm that can appear yellow, green, or brown.

Contact your doctor if you are concerned about a cough.

Learn more about wet coughs here.

When should I go to the ER for coughing up blood?

Coughing up a little blood is not always serious. Sometimes, the bleeding that causes a bloody cough will stop on its own. However, even in this case, you should still contact a doctor for advice as soon as possible after first coughing up blood.

In other cases, the bleeding can be severe, with up to 1 in 20 people who experience coughing up blood for the first time producing severe amounts of blood.

As hemoptysis can constitute a potentially life threatening medical emergency, it is important to seek immediate medical help for any severe symptoms.

Serious symptoms that may accompany coughing up blood

Serious symptoms that require evaluation in an emergency setting can include:

  • large amounts of blood produced by the cough, such as coughing up more than a few teaspoons of blood
  • dizziness or lightheadedness
  • a fever
  • shortness of breath
  • blood in your urine or stool
  • a rapid heartbeat or pulse
  • chest pain
  • pain in your upper back

Diagnosing the cause of hemoptysis

Your doctor will run tests to find the cause of coughing up blood.

To diagnose a condition, your doctor will evaluate your symptoms, any conditions you already have, any treatments you may already be receiving, and your medical history.

If they suspect that the blood is coming from your lungs, testing will be necessary to find the cause. This can include tests such as:

  • sputum culture or smear
  • complete blood count for blood cells and platelets
  • imaging scans, such as X-rays or CT scans
  • lung biopsy
  • bronchoscopy to view the airway and lungs
  • angiography to show the blood flow of the lungs
  • blood clotting tests, such as prothrombin time or partial thromboplastin time tests

The results of these hemoptysis tests will help your doctor design a treatment plan, as treatment will depend on the underlying cause.

What are the treatments for coughing up blood?

Treatments will aim to control and stop the bleeding that is underlying coughing up blood.

In mild cases, coughing up blood may improve or stop on its own, and your doctor may advise minimal treatment after checking your condition.

Treating other cases depends on the underlying cause. For example, the most common causes include infections and inflammation, so mild cases may be treatable by addressing the underlying infection or taking anti-inflammatory measures.

Treating severe hemoptysis may require emergency intervention. Because pulmonary bleeding — which can cause coughing up blood — can fill the airways with blood, emergency interventions will aim to keep the airways free of blood to ensure safe breathing.

Treatments for mild and serious cases of coughing up blood can include:

  • the treatment of the underlying infection
  • anti-inflammatory medications
  • anticoagulant medications
  • bronchoscopy
  • endovascular treatment, such as bronchial artery embolization
  • surgical treatment

At-home remedies for coughing up blood

If your doctor diagnoses a mild respiratory infection as the cause of hemoptysis, some at-home remedies may help improve coughing up blood.

Tips for self-care with mild respiratory infections and coughs include:

  • resting
  • drinking plenty of fluids and staying hydrated
  • taking acetaminophen or ibuprofen to treat any pain
  • drinking hot liquids, such as hot honey and lemon, though this is not safe for children younger than 1 year of age
  • with the guidance of a pharmacist or doctor, taking cough syrup, cough medications, or cough sweets

Only limited evidence suggests that these methods actually treat coughs, but they may still help make you feel better.

Certain treatments, particularly cough syrups and sweets, are not appropriate or safe for everyone. This is especially the case for children under the age of 6 years.

Contact your doctor for advice on treating a mild cough or if symptoms do not improve with at-home treatment.

What are the potential complications of coughing up blood?

The complications of an untreated or poorly controlled cough that contains massive quantities of blood can be serious and even life threatening.

Over time, coughing up blood and the accumulation of blood in the airways may have serious complications and cause permanent damage, including asphyxia and death.

Coughing up blood can also indicate an underlying condition that may present its own complications if not treated, which may also result in permanent damage or death.

Summary

Coughing up blood is also known as hemoptysis. It refers to a cough that produces bloody fluid or mucus. Liquid from a cough that contains blood can appear frothy and pink, bright red, or rust colored red. Alternatively, it can have minimal streaks and spotting of blood.

Coughing up blood is commonly the result of mild respiratory infections. However, in serious cases, it may be a symptom of a severe or life threatening disease, such as lung cancer, an autoimmune condition, or pulmonary embolism.

Treatment will depend on the cause of coughing up blood. In mild cases, treatment can include at-home remedies for temporary discomfort. In serious cases, comprehensive medical intervention may be required to prevent potentially fatal complications.

You should contact your doctor as soon as possible for any cough containing blood or blood in the airways, even if you suspect the cause to be minor.

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Medical Reviewer: Carissa Stephens, R.N., CCRN, CPN
Last Review Date: 2022 Mar 29
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