Are You Coughing Up Blood? Let’s Understand Hemoptysis

It started like any other morning. Rina, a 34-year-old architect, was brushing her teeth when she noticed something strange. She coughed, expecting the usual morning throat clearing, but this time, there was a streak of red in the sink. 

"At first, I thought it might be nothing — maybe I’d brushed my gums too hard," she recalls. But the cough persisted, and the blood became more noticeable throughout the day. 

That’s when fear set in.

Haemoptysis: Not just a chest cold

Haemoptysis refers to the expectoration (coughing up) of blood or blood-streaked sputum from the lower respiratory tract. It can range from mild to massive bleeding and is often a symptom of an underlying respiratory condition. Common causes include infections such as tuberculosis or bronchitis, chronic lung diseases like bronchiectasis and chronic obstructive pulmonary disease (COPD), pulmonary embolism, or malignancies such as lung cancer. Although mild haemoptysis may result from something as benign as a respiratory tract infection, persistent or heavy bleeding requires prompt medical evaluation to determine the cause and appropriate treatment.

Rina was experiencing haemoptysis, the medical term for coughing up blood, which comes from the respiratory tract (the lungs, airways, or throat). The amount and appearance of the blood can vary from a slight streak in the mucus to large amounts that indicate more serious problems. Coughing up blood is never normal, and it’s crucial to get evaluated by a healthcare professional to determine the cause. Here, we will look at the causes of haemoptysis and understand what you should do if you notice blood in your cough. 

Here’s what coughing up blood could mean for your lungs

In haemoptysis, when you cough, blood mixes with mucus, and it can range in colour from bright red to pink and frothy. This blood comes from the respiratory tract, not the stomach or throat. It usually happens because there’s irritation or damage in the airways or lungs, causing bleeding. Coughing up blood is the most common symptom of tuberculosis in India.

While seeing blood in your cough can be alarming, it’s important to understand that haemoptysis itself is just a symptom. It is important to find out where the bleeding is coming from and what might be causing it.

Coughing vs vomiting blood: How to tell the difference

Although both haemoptysis and hematemesis involve blood, they come from different parts of the body and have distinct characteristics.

Haemoptysis is the act of coughing up blood that comes from the respiratory system (lungs or airways). The blood is usually mixed with mucus and tends to be bright red or pink with a frothy texture.

Hematemesis, on the other hand, is vomiting blood that originates from the gastrointestinal tract (stomach or oesophagus). Due to the reaction with stomach acid, the blood is darker and may look like coffee grounds.

Because coughing or gagging can occur during both conditions, it’s possible to confuse the two. In some cases, vomited blood may be accidentally inhaled into the lungs and then coughed up, making it appear similar to haemoptysis. Understanding where the blood is coming from is key to determining the underlying cause.

Coughing up blood can vary in severity. In Rina’s case, the amount of blood increased, and she started feeling short of breath, which pushed her to visit the doctor. When Rina visited the hospital, she was immediately sent for a series of tests.  “The doctors took it seriously from the start. I had several tests and scans all within hours,” she shares. The varied tests help doctors pinpoint the cause of haemoptysis and assess how serious it is.

When is haemoptysis an emergency?

“I was scared, but once I started struggling to breathe, I knew I needed help right away," Rina says. Coughing up blood can be alarming, but not every case is a medical emergency. However, it becomes an urgent situation if:

• You are coughing up large amounts of blood (over a few teaspoons)

• You experience shortness of breath or chest pain

• You feel lightheaded or faint

• You have a rapid heartbeat

Can haemoptysis be fatal?

Yes, haemoptysis can be life-threatening, particularly if there is a lot of blood loss or if severe conditions like lung cancer or a pulmonary embolism cause the episode. Large amounts of blood can block the airways, making breathing difficult and potentially causing suffocation. 

Massive haemoptysis, defined as coughing up more than 200-600 millilitres of blood within 24 hours, is a medical emergency and requires immediate intervention.

“The most common cause of death in a patient who coughs up blood is not the total amount of blood lost but asphyxiation or choking due to a clot completely blocking the breathing tubes,” Dr Aditya Agarwal, a chest physician based in Mumbai.

Common causes of haemoptysis

In Rina’s case, the diagnosis was viral pneumonia, an infection that inflames the lung tissue, which sometimes leads to bleeding. Other common causes of haemoptysis include:

• Lung infections such as pneumonia or tuberculosis can inflame the lung tissue, leading to blood coughing. Post-tuberculosis lung damage can also cause recurrent haemoptysis, especially if there is a fungal infection (fungal ball - aspergilloma).

• Chronic respiratory conditions like bronchitis, bronchiectasis, or cystic fibrosis can cause persistent lung damage and irritation, which may result in blood in the cough.

• Lung cancer can erode blood vessels in the lungs, causing bleeding that appears in the sputum.

• A blood clot in the lung, known as a pulmonary embolism, can cause bleeding when it blocks blood flow to lung tissue.

• Pulmonary aspiration, or inhaling food or other material into the lungs, can cause injury or irritation that leads to haemoptysis.

• Specific medical procedures may temporarily cause bleeding in the airways.

• Severe coughing or trauma to the lungs can cause minor bleeding due to irritation of the throat or airways.

• Pulmonary oedema, which is fluid accumulation in the lungs, can sometimes result in blood-tinged sputum.

• Blood clotting issues, especially from high doses of certain medications, can make it easier for bleeding to occur in the lungs.

Massive haemoptysis vs mild haemoptysis

Mild haemoptysis involves small amounts of blood, often just streaks in the sputum. It is usually caused by minor infections or inflammation, such as bronchitis, and is rarely life-threatening. Though alarming, it often resolves with basic treatment and monitoring.

Massive haemoptysis, however, refers to the coughing up of large volumes of blood, typically over 200-600 ml in 24 hours and is a medical emergency. It can block the airways, cause severe breathing difficulty, and may be life-threatening without immediate intervention. Causes include serious conditions like tuberculosis, lung cancer, or major blood vessel rupture.

The urgency of intervention differs significantly. Mild cases may only require conservative treatment and monitoring, whereas massive haemoptysis demands rapid diagnosis, stabilisation of the airway, and often interventional procedures like surgery.

Outcome and prognosis are also dependent on the severity and underlying cause. While mild haemoptysis often resolves with treatment of the primary condition, massive haemoptysis carries a high mortality risk without prompt intervention.

How to treat haemoptysis

Dr Aditya Agarwal, a chest physician based in Mumbai, says, “Identifying the source of bleeding becomes essential for establishing the right management plan. Most often, the quantity of blood coughed up is small, requiring no treatment. However, if somebody has difficulty breathing or goes into shock, the treatment becomes quite radical.” 

For more serious causes of haemoptysis, treatment might involve surgery or medications to control the bleeding. 

Don't wait: Your health deserves immediate attention

Haemoptysis is an unsettling symptom that can signal a range of medical issues, from infections like pneumonia to serious conditions like lung cancer. While not all cases are life-threatening, coughing up blood is always cause for concern. 

Rina’s experience highlights the importance of seeking prompt medical care and staying proactive about lung health.

"I’m just glad I acted quickly. If I hadn’t, things could have been much worse," Rina reflects. Her story is a reminder that when it comes to our health, it’s better to be cautious and get checked out rather than risk a more severe outcome.

Frequently Asked Questions

1. What is haemoptysis?

Haemoptysis is the medical term for coughing up blood or blood-streaked mucus from the lungs or airways.

2. Is coughing up a little blood serious?

Even small amounts should be checked by a doctor, as they can be an early sign of an underlying condition.

3. What causes haemoptysis?

Common causes include chest infections, chronic lung disease, tuberculosis, and, in some cases, lung cancer.