Coughing up blood is called hemoptysis (pronounced “he-MOP-tih-sis”). The sight of blood anywhere is enough to send shivers down the spine of any mortal being. Imagine coughing out blood every now and then. Even the thought of it is scary. But if and when it happens it is a concerning symptom that should not be ignored. It is important to understand what might be causing it, what to do if it happens, and what treatments are available. This article will provide an overview of this condition, including what to do if you notice blood in your cough.
Introduction
Coughing up blood, or hemoptysis, is an alarming symptom that should not be ignored. It involves spitting up blood or bloody mucus from your lower respiratory tract (lungs and throat). It can be a sign of a serious underlying condition and should be evaluated by a doctor. Hemoptysis often can be a ‘lucky’ symptom allowing diagnosis of a small lung cancer or bronchial adenoma. Many patients present to us in our clinic with this complaint. Typically it starts with just a “streak or tinge of red” in the sputum, wherein its more phlegm and less blood. Gradually the quantity of blood starts increasing to maybe a teaspoon or tablespoon. Often patients cough up massive amount of blood (100-200ml ) with every bout of cough. The frequency of such episodes may also go up with time.
What causes blood in the cough?
While hemoptysis is a tell-tale sign of lung cancer, it is more often due to a benign cause. It can be caused by a number of conditions, including infections, lung diseases like emphysema and bronchiectasis. It can also be caused by trauma to the lungs, such as a blunt force injury or a foreign object lodged in the lungs.
Infections are the most common cause of hemoptysis. These can include bacterial, viral, parasitic (Hydatid Cyst), and fungal infections. A special kind of fungal infection called “Aspergilloma” is very often seen in the Indian scenario wherein a fungal ball will be found inside a cavity in the lung. Tuberculosis and pneumonia are the most common causes of infectious hemoptysis. Even after Tuberculosis has been treated and cured it may still leave behind its sequelae in the lungs. These can cause blood in cough many days, months or even years after completion of full treatment of Tuberculosis.
Other causes of hemoptysis include heart failure, lung cancer, pulmonary embolism, and pulmonary hypertension.
What to do if you notice blood in your cough?
Although just the presence of blood in cough is a reason enough to see a doctor, coughing out massive amounts of blood is an emergency and should not be ignored at any costs. Losing too much blood at once can be life-threatening not only because of loss of blood from the body but also because of the risk of drowning in your own blood when they fill up your airways leading to suffocation. You need to visit an ER immediately if you’re coughing up large amounts of blood.
In the meantime, there are certain measures that you can take to help relieve the symptoms.
If you are coughing up a lot of blood, it is important to remain calm and try to minimize the amount of coughing. You should avoid activities that could cause further coughing, such as strenuous activity or smoking. Additionally, it is important to take deep, slow breaths to help increase the oxygen levels in your lungs.
Diagnostic tests for hemoptysis
Your doctor will try to ascertain the exact reason why is there blood in your cough because there can be many reasons for this. They will likely order a series of tests to determine the underlying cause. These tests may include a chest X-ray, a sputum culture, a bronchoscopy, and a CT scan.
A chest X-ray can help your doctor evaluate the size and shape of your lungs and detect any abnormalities. A sputum culture is a test to check for the presence of bacteria or fungi in your sputum, which can indicate an infection. Bronchoscopy is a procedure where a small camera is inserted into your airways to evaluate for abnormalities. A CT scan can help your doctor detect any tumors or a fungal ball or any other other gross abnormalities in your lungs.
Treatment options for Coughing Up Blood
The treatment for hemoptysis will depend on the underlying cause. But while the doctors look for the cause they would start some treatment for blood loss related to coughing up blood which may include:
1. Medicines
They are used to stop bleeding related to severe blood loss (like tranexamic acid)
2. Bronchoscopy
To remove clots in your airways. They may use one of these methods or a combination to see if they can control the bleeding bronchoscopically:
- Cold saline lavage
- Topical vasoconstrictor agents
- Balloon tamponade
- Laser photocoagulation
- Argon plasma coagulation
- Electrocautery
3. Bronchial Artery Embolization (BAE)
This is used to stop blood flow in blood vessels that are causing your bleeding. BAE is a procedure done by Intervention Radiologists where they block the culprit blood vessels (bronchial arteries) feeding the area of lung which is the source of bleeding. If BAE is successful you may get rid of the bleeding at least temporarily
4. Blood transfusion
To replace the lost blood in case it is a lot and has caused a drop in Haemoglobin.
Once a cause is found, your doctor will address it. Treatments may include:
- Antibiotics: If pneumonia or tuberculosis is the culprit.
- Steroids: If inflammation is causing your condition.
- Surgery: If a malignant (cancerous) tumor or a gross lung cavity is causing your condition. Also sometimes you may not respond to medicines and repeated BAEs may also fail. In such situation also you may be referred for a surgery. The cause here is usually a structural damage in some part of the lung or some other parenchymal abnormality which is the source of the recurrent bleeding. The goal here is source control, which means removing the damaged part of the lung. This is where a Thoracic (Chest) surgeon gets involved. He or she will evaluate your CT scans and identify the damaged portion of the lung and advice you for a surgical removal of that part.
Surgery for Coughing Up Blood
In some cases, surgery may be necessary to treat hemoptysis. Surgery is performed in case of persistent or recurrent hemoptysis that can not be controlled by non-surgical treatment and in whom the lesions could be anatomically localized and confirmed by CT or bronchoscopy.
Surgery may involve removal of the tumour or other affected tissue, or it may involve using a stent or other device to help keep the airways open.
Depending on the extent of damage or size of tumour, the following types of surgeries may be offered:
- Wedge Resection – It is a non anatomical resection of a small part of the lung
- Segmentectomy – Removal of one or a combination of broncho-pulmonary segments
- Lobectomy – Resection of one out of the three lobes on right side or one out of the two lobes on the left side
- Bilobectomy – It is the removal of two lobes together
- Pneumonectomy – Complete removal of one lung
*Interesting read: Can you live with one lung?
Out of all these surgeries, lobectomy and wedge resections are the most common. They can be done by either the Open Approach or the Minimally Invasive Approach (VATS or Robotics)
Prevention of Coughing Up Blood
The best way to prevent hemoptysis is to take steps to reduce your risk of developing an infection or other underlying condition that could cause it. This includes avoiding smoking and exposure to secondhand smoke, getting vaccinated against illnesses like tuberculosis and pneumonia, and washing your hands regularly with soap and water.
It is also important to practice good hygiene and be aware of the symptoms of infection so that you can seek medical attention as soon as possible. Additionally, it is important to maintain a healthy weight and eat a balanced diet to help reduce your risk of developing a lung disease.
Advice From Dr. Kamran Ali
Don’t panic if you’re coughing up small amounts of blood. But be alert and vigilant. It’s important to know what’s causing this symptom, so see a specialist on priority. Regardless of the cause, the sooner you receive treatment, the better. It is vital to seek medical attention if the hemoptysis persists for more than a couple of days or if it is accompanied by other symptoms, such as shortness of breath, chest pain, or fever.
