Top 5 Causes of Coughing Up Blood

What is coughing up blood?

When you cough up blood (also called hemoptysis), the blood is coming from your airways (pulmonary and bronchial arteries) or your lungs. You may feel chest pain or shortness of breath as well.

The areas around and in the lungs are filled with many blood vessels. These include arteries that bring oxygen and nutrients to the lungs and airways, and smaller vessels (capillaries) that absorb oxygen from the lungs and distribute it to the rest of the body. Damaged or diseased vessels can lead to blood being coughed up.

Bleeding from the nose or throat or from the esophagus and stomach may be mistaken for hemoptysis.

Coughing up blood may be mild or life-threatening. Signs that it’s life-threatening include coughing up more than half a cup of blood within 24 hours, difficulty breathing, and dizziness or lightheadedness. If you experience these symptoms you need emergency attention.

Depending on the cause and severity, treatment may include medication, hospitalization for monitoring, a breathing tube and ventilator, procedures to look in your airway (bronchoscopy) or to block a blood vessel, or surgery.

Causes

1. Bronchiectasis

Symptoms

• Coughing up blood
• Chronic coughing, chronic sputum/phlegm
• Shortness of breath
• Frequent pneumonias

Bronchiectasis is when your airways are permanently widened, according to the American Lung Association. People with bronchiectasis have difficulty clearing out the mucus in their airways and often get bacterial infections (pneumonia). Cystic fibrosis is a common cause of bronchiectasis, but there are many others.

Bronchiectasis is diagnosed with a computed tomography (CT) scan, often with a test of your pulmonary function, and blood tests.

Bronchiectasis causes inflammation and irritation of the airways, which can cause people to cough up blood. It appears as streaks of blood or a small amount of blood.

People with bronchiectasis need ongoing treatments including airway clearance, inhalers, possible antibiotics, or other treatments.

One complication of bronchiectasis is having tortuous (thick and winding) blood vessels in the airways. This can cause life-threatening bleeding.

For severe cases, treatments may include hospitalization for monitoring, a breathing tube and ventilator, bronchoscopy, surgery, or a procedure to block a vessel.

2. Acute bronchitis

Symptoms

• Several weeks of persistent cough with no other symptoms
• Blood streaks in sputum

Bronchitis is an infection and inflammation of the airways. It is commonly caused by viruses like influenza (the flu). You should be tested for and treated for the flu.

Other causes go away on their own, but you may have symptoms for weeks. There is no specific treatment for blood streaks in sputum. You can try hot tea, honey, and over-the-counter medications to help with the cough.

3. Tuberculosis (TB)

Symptoms

• Coughing up blood
• Fever, night sweats
• Weight loss
• Fatigue
• Cough
• Chest pain
• Exposure to someone who had TB or traveled to a country where it is common

Tuberculosis (TB) is a bacterial infection of the lungs (pneumonia) caused by Mycobacterium tuberculosis. The condition can also affect other organs in the body.

TB causes problems in people with conditions that weaken their immune system or who have a high risk for the condition, such as:

• Being in close contact with someone with TB.
• Traveling to an endemic country.
• Working or living in a homeless shelter.
• Working or living in prison.

Most people exposed to TB are able to fight it off without issues, although the TB remains dormant in the body. They may develop symptoms later in life if their immune system becomes weaker.

The treatment for TB is several daily antibiotics for at least 6 months. It is very important to take every dose in order to get well. TB in the lungs can cause cavitary disease (where ball-like cavities occur) or other scarring that can bleed, especially if not treated properly.

TB cavitary disease can erode the lung tissue and blood vessels of the airways, causing life-threatening bleeding.

For severe or life-threatening cases, treatments may include hospitalization for monitoring, a breathing tube and ventilator, bronchoscopy, surgery, and a procedure to block a bleeding vessel.

4. Cancer

Symptoms

• Coughing up blood
• Fevers, night sweats
• Weight loss
• Fatigue
• Cough
• Chest pain
• Shortness of breath

Cancers involving the airway or lungs can bleed. This may also include lung cancer or cancer from another organ, such as the kidneys, that has spread to the lung or airways.

The cancer needs to be treated, usually through a combination of surgery, chemotherapy or other medications, and/or radiation. Sometimes cancer spreads and erodes the lung tissue and blood vessels of the airways, which can cause life-threatening bleeding.

For severe or life-threatening cases, treatments may include hospitalization for monitoring, a breathing tube and ventilator, bronchoscopy, surgery, or a procedure to block a bleeding vessel.

5. Fungal infection

Symptoms

• Coughing up blood
• Fevers, night sweats
• Weight loss
• Fatigue
• Cough
• Chest pain
• Shortness of breath

Fungal infections that cause coughing up blood are more common in people who have conditions that weaken their immune system, previously had a cavitary lung disease (such as from a lung infection like tuberculosis), or have a chronic lung disease like chronic obstructive pulmonary disease (COPD).

Possible infections include Aspergillus and Mucor. Treatment includes antifungal medications for at least several weeks. You may also need surgery to remove the area of tissue infected by the fungus.

Sometimes severe fungal infections can weaken lung tissue and blood vessels of the airways, causing a blockage that leads to tissue death and even life-threatening bleeding.

For severe or life-threatening cases, treatments may include hospitalization for monitoring, a breathing tube, and ventilator, bronchoscopy, surgical intervention, or a procedure to block a vessel.

Other possible causes

• Heart failure
• Pulmonary embolism (blood clot in lung blood vessels)
• Use of anticoagulation medications (blood thinners, like warfarin)
• Pneumonia
• A lung abscess
• Rheumatologic conditions (like anti-glomerular basement membrane disease)
• Endometriosis
• Malformations of your blood vessels
• Certain prescription and illicit drugs (like cocaine)
• A foreign body in the lungs or airways

When to call the doctor

You should let your doctor know about any coughing up blood or bloody sputum.

You may receive additional tests, including blood tests, a chest X-ray or CT (computed tomography) scan, sputum tests, an echocardiogram, or a lung function test. This is particularly important if you also experience fever or weight loss.

Should I go to the ER?

You should go to the emergency department if you have any of these signs of a more serious problem.

• Coughing up more than half a cup of blood within 24 hours
• Difficulty breathing
• Dizziness/lightheadedness
• Hemoptysis that lasts for days