Coughing up blood is not normal. See a doctor promptly, and seek emergency care if it is a large amount.
Not normal
Coughing up blood (hemoptysis) always needs a doctor’s visit.
Causes
- Bronchitis and pneumonia.
- Tuberculosis.
- Pulmonary embolism.
- Lung cancer.
- Heavy coughing.
Amount
A streak is less worrying than a large amount.
See a doctor
Promptly.
Emergency
Call 911 for more than a teaspoon of blood, chest pain, shortness of breath or dizziness.
Terms and amounts
Coughing up blood (hemoptysis) is not normal. It can be streaks or a mix with mucus, or frank blood. Massive hemoptysis, often defined as over 100 to 600 mL in 24 hours, can cause airway blockage and requires emergency care.
- Acute bronchitis and pneumonia are common causes of streaked sputum.
- Tuberculosis, lung cancer, bronchiectasis, pulmonary embolism, heart failure and vasculitis are other causes.
- Chronic smokers and people over 40 have higher risk of lung cancer causing hemoptysis.
- Nose or throat bleeding can mimic it, as can vomiting blood.
What to do
Note the color, amount and timing. See a doctor the same day for any blood. Tests include chest X-ray, CT scan, blood tests and bronchoscopy. Call emergency services if blood is more than a teaspoon, with trouble breathing or chest pain, if you take blood thinners, or if it keeps recurring. Sit upright and avoid lying flat.
Terms and amounts
Coughing up blood (hemoptysis) ranges from streaks to large volumes. It may come from the airways or lungs, whereas blood from the stomach is vomited and darker. Causes include bronchitis, pneumonia, tuberculosis, lung cancer, pulmonary embolism and blood vessel malformations. Smokers face higher risk.
What to do
See a doctor promptly for any coughing blood. Go to the emergency room for large amounts, breathlessness, chest pain or fainting. Tests include chest X ray, CT scan, bronchoscopy and blood tests.
Differences in appearance and causes
Coughing blood is frothy and bright red, mixed with mucus. Chronic bronchitis causes streaks in smokers. Pulmonary embolism produces hemoptysis in about 5 to 10 percent of cases with chest pain and shortness of breath. Heart failure with mitral stenosis can cause pink frothy sputum, and Goodpasture syndrome and vasculitis involve kidneys.
Immediate action
Sit upright, lean toward the affected side if known, and call 911 if blood is more than a tablespoon or you have breathing trouble. Avoid taking aspirin. Doctors may do CT of the chest, bronchoscopy and coagulation tests. Treating infection, stopping smoking and addressing the cause prevents recurrence.
Based on data from the American Lung Association and the Mayo Clinic
