Hemoptysis (Coughing up Blood) Treatment in Delhi, India

Hemoptysis, also known as coughing up blood or bleeding lungs, is a medical term referring to the coughing up of blood or blood-stained mucus from the respiratory tract. It occurs when blood vessels in the lungs or airways are damaged or ruptured, leading to bleeding into the air passages. Hemoptysis can vary in severity, ranging from mild blood streaks in sputum to large volumes of blood being expelled during coughing. It can be caused by various underlying conditions, including respiratory infections, lung diseases (such as pneumonia, tuberculosis, or lung cancer), pulmonary embolism, bronchitis, bronchiectasis, and certain cardiovascular conditions. Hemoptysis requires prompt medical evaluation to determine the underlying cause and initiate appropriate treatment. It is essential to seek medical attention if someone experiences hemoptysis or coughs up blood, it can be a sign of a potentially serious or life-threatening condition.

Hemoptysis, or coughing up blood from the respiratory tract, can be classified into several types based on severity and potential threat to life. Here are three common types:

Mild or Scant Hemoptysis

Mild hemoptysis, also referred to as scant hemoptysis, involves the coughing up of a minimal amount of blood or blood-stained mucus. This type of hemoptysis may present as blood streaks or spots in the sputum and is often associated with less severe underlying conditions. While mild hemoptysis may not be immediately life-threatening, it should still prompt medical evaluation to determine the cause and appropriate management.

Life-Threatening or Massive Hemoptysis

Life-threatening hemoptysis, also known as massive hemoptysis, refers to the coughing up of a large volume of blood, typically exceeding 100 millilitres within a 24-hour period. This type of hemoptysis can be severe and may lead to significant respiratory compromise and even death if not promptly managed. In such cases, immediate medical attention is required to stabilise the patient and address the underlying cause of bleeding.

Regardless of the type, any episode of hemoptysis should be taken seriously, and individuals experiencing it should seek medical attention promptly for evaluation and appropriate care.

There are many potential causes of hemoptysis, ranging from common and benign to serious and life-threatening. Here are some of the most common causes:

Infections

• Bronchitis: This is an inflammation of the airways in the lungs, which can cause coughing, irritation, and sometimes hemoptysis. Acute bronchitis is usually caused by a viral infection, while chronic bronchitis is often linked to smoking.
• Pneumonia: This is an infection of the lung tissue itself, which can cause a variety of symptoms, including fever, cough, shortness of breath, and hemoptysis. Pneumonia can be caused by bacteria, viruses, or fungi.
• Tuberculosis: This is a contagious bacterial infection that primarily affects the lungs. It can cause coughing, chest pain, weight loss, and hemoptysis.

Respiratory Diseases

• Chronic obstructive pulmonary disease (COPD): This is a group of lung diseases that includes emphysema and chronic bronchitis. COPD can cause coughing, wheezing, shortness of breath, and hemoptysis.
• Pulmonary embolism: This is a blood clot that lodges in an artery in the lungs. It can cause sudden shortness of breath, chest pain, and hemoptysis.

Cardiovascular Conditions

• Pulmonary edema: This is a buildup of fluid in the lungs, which can be caused by heart failure, high blood pressure, or other medical conditions. It can cause cough, shortness of breath, and hemoptysis.
• Mitral valve stenosis: This is a narrowing of the mitral valve in the heart, which can lead to congestion in the lungs and hemoptysis.

Other Causes

• Lung cancer: This is a serious condition that can cause a variety of symptoms, including cough, weight loss, chest pain, and hemoptysis.
• Bronchiectasis: Bronchiectasis is a condition in which the airways in the lungs become abnormally widened and damaged. It can cause cough, recurrent infections, and hemoptysis.
• Foreign object inhalation: Inhaling a foreign object, such as a piece of food or a small toy, can irritate the airways and cause coughing, hemoptysis, and other respiratory problems.
• Some other causes include - vasculitis , vascular anomalies , bronchovascular fistula

It is important to note that this is not an exhaustive list of all possible causes of hemoptysis. If you are experiencing hemoptysis, it is important to see a doctor right away to determine the underlying cause and get appropriate treatment.

Diagnosing the cause of hemoptysis often involves a multi-step approach to identify the underlying source of the bleeding. Here's a general overview of the diagnostic process:

Initial evaluation

• Medical history: The doctor will inquire about your symptoms, including the amount and colour of blood coughed up, any other respiratory issues, medical history, and lifestyle habits (smoking, exposure to irritants).
• Physical examination: This may involve checking your vital signs, listening to your lungs for abnormal sounds, and examining your nose, throat, and chest for signs of infection or other abnormalities.

Diagnostic Tests

• Chest X-ray: X-ray provides a basic image of your lungs and heart, potentially revealing abnormalities like pneumonia, tumours, or fluid buildup.
• Sputum analysis: Examining coughed-up mucus can help identify infections like pneumonia or tuberculosis.
• Bronchoscopy: Bronchoscopy involves inserting a thin, flexible tube with a camera through your nose or mouth into your airways to directly visualise the source of bleeding.

Additional Tests

Depending on the initial findings, further investigations might be necessary, such as:

• CT scan of the chest: CT scan provides more detailed images of your lungs and surrounding structures, offering a clearer picture of potential abnormalities.
• Angiography: Angiography uses contrast dye to visualise blood vessels and identify potential vascular malformations or bleeding sources.
• Biopsy: In some cases, a tissue sample from the lungs or airways might be obtained for further analysis to confirm a diagnosis like lung cancer.

The specific diagnostic tests chosen will depend on your individual situation and the doctor's initial assessment.

The treatment for hemoptysis, or coughing up blood from the respiratory tract, depends on the underlying cause, severity of bleeding, and individual patient factors. Here's an overview of treatment options:

Address Underlying Cause

The primary goal of treatment is to address the underlying cause of hemoptysis. This may involve treating respiratory infections with antibiotics, managing chronic lung conditions such as bronchitis or COPD with bronchodilators or corticosteroids, or treating lung cancer with surgery, chemotherapy, or radiation therapy.

Airway Management

In cases of significant bleeding or respiratory distress, airway management may be necessary to maintain adequate oxygenation and ventilation. This may involve interventions such as suctioning to remove blood from the airways, supplemental oxygen therapy, or mechanical ventilation in severe cases.

Medications

Depending on the cause of hemoptysis, medications may be prescribed to help control bleeding or manage symptoms. These may include:

• Antifibrinolytic medications (such as tranexamic acid) to help stabilise blood clots and reduce bleeding.
• Cough suppressants to help alleviate coughing and reduce irritation of the airways.
• Antibiotics to treat underlying respiratory infections.
• Bronchodilators open up the airways and improve airflow in conditions like asthma or COPD.
• Corticosteroids to reduce inflammation in conditions like bronchitis or autoimmune disorders.

Bronchial Artery Embolization (BAE)

In cases of massive or recurrent hemoptysis that cannot be controlled with conservative measures, bronchial artery embolization (BAE) may be performed. This minimally invasive procedure involves injecting a clotting agent or embolic material into the blood vessels supplying the lungs to block off the source of bleeding.

Surgery

Surgical intervention may be necessary in certain cases of hemoptysis, for example:

• Lung resection surgery to remove tumours or diseased lung tissue.
• Lobectomy or pneumonectomy to remove a portion or the entire affected lung.
• Bronchial artery ligation to tie off or block the blood vessels supplying the bleeding area.

Bronchoscopic interventions like placement of fogarty cather/ endobronchial blockers to block the bleeding lung segment may be required in cases of massive hemoptysis in the emergency or icu . We have a dedicated respiratory icu which is fully equipped with fiberoptic bronchoscope and other requirements to handle an emergency related to massive hemoptysis.

What is the difference between coughing up blood (Hemoptysis) and vomiting blood (Hematemesis)?

Hemoptysis refers to coughing up blood originating from the lungs or airways. The blood may be bright red, pink, or frothy, depending on the source and how long it has been in the airways.

Hematemesis, on the other hand, refers to vomiting blood originating from the upper digestive tract, such as the stomach or oesophagus. The blood is typically darker red or brown, often resembling coffee grounds due to its interaction with stomach acid.

Can hemoptysis be life-threatening?

Yes, hemoptysis can be life-threatening, especially in cases of massive hemoptysis, where a large amount of blood is coughed up (exceeding 100 ml in 24 hours). This can lead to airway obstruction, respiratory failure, and even death.

Is hemoptysis a type of cancer?

Hemoptysis itself is not a cancer, but it can be a symptom of underlying conditions such as lung cancer, bronchitis, tuberculosis, or other respiratory diseases.

How does hemoptysis affect respiratory function?

Depending on the severity and location of bleeding, hemoptysis can affect respiratory function in various ways:

• Blocked airways: Blood clots can obstruct airways, making breathing difficult and reducing oxygen intake.
• Inflammation: Bleeding can irritate and inflame the airways, leading to wheezing, shortness of breath, and coughing.
• Fluid buildup: In severe cases, blood can accumulate in the lungs (pulmonary edema), further compromising gas exchange and causing respiratory distress.

Can hemoptysis be a symptom of lung cancer?

Yes, hemoptysis can be a symptom of lung cancer, but it is not the most common symptom and occurs in only a minority of cases. It's important to note that other, more prevalent conditions can also cause hemoptysis.

What are the risk factors for developing hemoptysis?

Several factors can increase your risk of developing hemoptysis, including:

• Smoking: The leading risk factor, damaging lung tissue and increasing the risk of infections and other conditions that can cause bleeding.
• Respiratory infections: Bronchitis, pneumonia, and tuberculosis can irritate and inflame airways, leading to coughing and sometimes hemoptysis.
• Chronic obstructive pulmonary disease (COPD): Emphysema and chronic bronchitis, components of COPD, can damage lung tissue and increase the risk of bleeding.
• Pulmonary embolism: A blood clot lodged in the lungs can damage blood vessels and cause hemoptysis.
• Cardiovascular conditions: Heart failure and high blood pressure can put strain on the lungs and increase the risk of bleeding.
• Lung cancer: Although less common, tumours in the lungs can erode blood vessels and cause hemoptysis.

When should I seek medical attention for hemoptysis?

Seek immediate medical attention if you experience any amount of coughing up blood, regardless of the quantity or colour. Prompt diagnosis and treatment are crucial to identify the underlying cause and prevent potential complications.

Is hemoptysis more common in certain age groups?

While hemoptysis can occur at any age, it is more common in adults between 40 and 60 years old, particularly those with risk factors like smoking or chronic lung conditions.

Can hemoptysis be prevented?

In some cases, hemoptysis can be prevented by:

• Quitting smoking: The most significant step to reduce the risk of various lung problems, including hemoptysis.
• Managing chronic lung conditions: Following treatment plans for conditions like COPD or asthma can help minimise inflammation and reduce the risk of complications.
• Avoiding secondhand smoke: Exposure to secondhand smoke can irritate the lungs and increase the risk of respiratory infections, potentially leading to hemoptysis.
• Maintaining good hygiene: Regularly washing hands and practising good respiratory hygiene can help prevent infections that might contribute to hemoptysis.

Can hemoptysis be managed at home?

No, hemoptysis should not be managed at home. It's crucial to seek immediate medical attention for proper diagnosis and treatment of the underlying cause. Trying to manage hemoptysis at home can be dangerous and potentially worsen the situation.

Reviewed by Dr. Priyanka Aggarwal, Principal Consultant - Pulmonology on 24 May 2024.