Hemoptysis

Hemoptysis is the medical term for coughing up blood or blood-streaked mucus from the lungs or airways. The amount of blood can vary widely, ranging from small streaks mixed with phlegm to larger amounts of active bleeding.

While mild hemoptysis may occur with irritation or infection, it can also be a sign of a more serious underlying lung condition. Because it is not always possible to determine the cause based on symptoms alone, evaluation by a pulmonologist is often recommended.

Hemoptysis can be caused by a wide range of respiratory and vascular conditions. Some causes are relatively minor, while others require urgent medical attention.

Common causes include:

• Bronchitis or respiratory infections

• Pneumonia

• Chronic obstructive pulmonary disease (COPD)

• Bronchiectasis

• Pulmonary embolism (blood clot in the lungs)

• Lung cancer or airway tumors

• Tuberculosis or fungal infections

• Trauma or irritation of the airways

• Bleeding disorders or blood-thinning medications

Because the causes vary significantly, identifying the source of bleeding is critical to determining the appropriate treatment.

Hemoptysis may be an emergency depending on the amount of blood and the patient’s symptoms. Small streaks of blood may not require hospitalization, but larger amounts can become dangerous quickly and may interfere with breathing.

Seek emergency care immediately if you experience:

• Large amounts of blood

• Shortness of breath or chest pain

• Dizziness, fainting, or weakness

• Rapid worsening symptoms

• Bleeding that does not stop

Even mild hemoptysis should be evaluated promptly, especially if it occurs repeatedly or has no clear cause.

Diagnosing hemoptysis begins with determining where the blood is coming from and what is causing it. Your pulmonologist will review your symptoms, medical history, medications, and risk factors such as smoking history or chronic lung disease.

The evaluation may include imaging and testing to rule out serious causes such as infection, pulmonary embolism, or malignancy. Because hemoptysis can be a symptom of high-risk conditions, timely evaluation is important even when the bleeding seems mild.

Several tests may be used to identify the source and severity of hemoptysis. These may include:

• Chest X-ray

• CT scan of the chest for detailed lung imaging

• CT angiography if a blood clot or vascular cause is suspected

• Laboratory testing to evaluate infection or clotting

• Pulmonary function testing when chronic lung disease is suspected

• Bronchoscopy to directly examine the airways and locate bleeding

Bronchoscopy is often used when imaging does not clearly identify the cause or when bleeding is persistent. It can also help guide treatment decisions.

Treatment for hemoptysis depends entirely on the underlying cause. In many cases, stopping the bleeding requires addressing infection, inflammation, or structural airway disease.

Treatment options may include:

• Antibiotics for bacterial infections

• Inhalers or steroids for airway inflammation

• Treatment of underlying COPD or bronchiectasis

• Adjusting blood-thinning medications when appropriate

• Bronchoscopy-based interventions in select cases

• Referral for interventional radiology procedures such as bronchial artery embolization for significant bleeding

• Coordinated oncology or surgical referral if a tumor is identified

At The Lung Docs, we focus on identifying the cause quickly and providing targeted treatment to prevent recurrence and protect lung function.

In some cases, hemoptysis may resolve on its own, particularly when it is caused by minor irritation, acute bronchitis, or a mild infection. However, even when bleeding stops, the underlying cause may still be present.

Recurring or unexplained hemoptysis should never be ignored. Persistent or repeated episodes may indicate a chronic lung condition or a more serious disease process that requires further evaluation.

You should see a pulmonologist anytime you cough up blood, even if the amount seems small. Early evaluation can prevent delays in diagnosing serious lung disease and may reduce the risk of complications.

A pulmonology visit is especially important if:

• Hemoptysis happens more than once

• You have a history of smoking

• You have COPD, bronchiectasis, or chronic lung disease

• You have fever, weight loss, or fatigue

• You experience shortness of breath or chest pain

• Imaging shows abnormalities such as nodules, masses, or infiltrates

At The Lung Docs, our board-certified pulmonologists provide prompt diagnostic workup and specialized care to determine the cause of hemoptysis and guide appropriate treatment.