What Does Coughing Up Blood (Hemoptysis) Mean?

Coughing up blood, medically known as hemoptysis, involves coughing or spitting up blood or blood-streaked mucus from your respiratory tract (i.e. lungs and airways). Coughed-up blood may appear pink, bright red, or rust-colored, and there may be a small or large amount, depending on the cause.

There are many possible causes for coughing up blood, including acute infections like bronchitis, chronic conditions like cystic fibrosis, a chest or lung injury, pulmonary embolism (blood clot in the lung), or medications like blood thinners. In some cases, coughing up blood can be an early symptom of lung cancer.

Coughing up blood can be an alarming experience, and while it is not often life-threatening, it does warrant a trip to your healthcare provider for diagnosis and treatment.

What Does Coughing Up Blood Look Like?

The appearance of coughed-up blood can vary in color and amount, depending on the source and cause of the bleeding. Here’s a breakdown of what blood you cough up may look like. 

Color

The color of coughed-up blood can range from pink to bright red to dark red or rust-colored, depending on the source of the bleeding. It is often mixed with air, making the blood appear bubbly or frothy. You may also cough up mucus tinged with blood, which can be mostly clear, yellow, or green in appearance.

Amount 

Coughing up blood can occur in small or large amounts. In most cases, the amount of blood coughed up is minimal. You may cough up blood-streaked mucus or large amounts of blood. Coughing up a large amount of bright red blood is an emergency and requires immediate medical attention.

Other Symptoms

You may have additional symptoms along with coughing up blood, depending on what's causing the bleeding. For example, if you have a respiratory infection or pneumonia, you may also have:

• Fever
• Persistent cough with mucus (phlegm)
• Chills
• Sore throat
• Headache
• Congestion (stuffy nose)

If you have a chronic condition causing you to cough up blood, such as cystic fibrosis, you may also experience symptoms associated with your diagnosis.

Types of Hemoptysis

Hemoptysis is categorized based on bleeding severity, meaning the volume of blood loss in 24 hours. This information helps guide the diagnostic process and help with making treatment decisions. Hemoptysis types include:

• Mild hemoptysis: A small amount of blood loss, less than 50 milliliters (mL), or about 1.69 fluid ounces, in 24 hours.
• Moderate hemoptysis: Moderate blood loss, ranging between 50 to 200 mL in 24 hours. 
• Massive (severe) hemoptysis: Severe blood loss, more than 200 mL in 24 hours, or 50 mL blood loss in one coughing episode.

Potential Causes

Hemoptysis occurs when there is bleeding in your lower respiratory tract, including the lungs, windpipe, bronchi, bronchioles, and alveoli. Sometimes, you may cough up blood from other sources, like your mouth or nose, known as pseudohemoptysis.

Many things can cause coughing up blood, ranging from minor to serious. 

Respiratory Infections 

Upper and lower respiratory infections, such as pneumonia, bronchitis, and tuberculosis, are among the most common causes of hemoptysis. Bacteria, viral, or fungal infections can inflame and irritate the airways and lungs, leading to a cough with mucus streaked with small amounts of blood. If you have a violent cough due to a respiratory infection, you may notice blood-streaked mucus when you cough.

People of all ages can develop respiratory infections, but certain groups are at a higher risk, including older adults, children, and people with chronic lung conditions (e.g., chronic obstructive pulmonary disease, asthma).

Lung Cancer

Up to 20% of people with lung cancer experience hemoptysis, and for many people who develop lung cancer, coughing up blood is the first sign. Bleeding can occur when a tumor irritates or grows into blood vessels in the lungs or surrounding tissues or when a chronic cough irritates the tissues of the respiratory tract. Although coughing up blood involves minor blood loss in most people with lung cancer, about 3% of all cases involve massive, life-threatening hemoptysis.

In addition to coughing up blood, other symptoms of lung cancer include a chronic cough, fatigue, unexplained weight loss, wheezing, and shortness of breath. Primary risk factors for lung cancer include smoking, long-term exposure to secondhand smoke or other irritants (e.g., air pollution, chemical dust), and a family history of lung cancer.

Pulmonary Embolism

A pulmonary embolism (PE), which is the medical term for a blood clot in the lungs, can cause hemoptysis. A PE occurs when a blood clot that develops in another part of the body, such as the leg, breaks free and travels through the bloodstream, where it becomes lodged in a pulmonary artery (in the lungs).

Symptoms of PE include coughing up blood, shortness of breath, chest pain, lightheadedness, and excessive sweating. Risk factors for developing a PE include smoking, having obesity, having an underlying lung or heart condition, and prolonged inactivity (e.g., bedrest, long-distance travel).

Bronchiectasis 

Bronchiectasis is a chronic lung disease that develops when the bronchi (airways) are damaged and permanently widen. It is a progressive condition that causes scarring and thickening of the bronchial walls, leading to mucus build-up in the airways and frequent respiratory infections.

With bronchiectasis, inflamed and irritated airways can lead to coughing up blood-tinged mucus or coughing blood. Other symptoms include chest pain, shortness of breath, and fatigue. Certain conditions can increase the risk of bronchiectasis, including cystic fibrosis, autoimmune diseases, immunodeficiency-related disorders (e.g., HIV/AIDS), and chronic obstructive pulmonary disease (COPD).

Other Causes

Though less common, other conditions and factors can cause coughing up blood, including:

• Cystic fibrosis 
• Anticoagulants (blood thinning medications), such as heparin or warfarin
• Heart failure 
• Vascular (blood vessel) disorders, such as vasculitis
• Drug use (e.g., cocaine)
• Trauma or injury to the lungs or airways
• Ingestion of a foreign (non-food) object
• Lung abscess (pus-filled cavity in the lung)
• Pulmonary edema (fluid build-up in the lungs)
• Bleeding disorders, such as hemophilia 
• Autoimmune disorders, such as systemic lupus erythematosus (often known simply as lupus)

When to See a Healthcare Provider

Coughing up blood can be an unsettling experience. While it isn’t usually life-threatening, it does require medical attention to determine the cause, as sometimes it is a sign of an underlying problem that requires diagnosis and treatment. 

See your healthcare provider promptly if you are coughing up blood or blood-tinged mucus and have a diagnosis or symptoms of an underlying condition associated with hemoptysis. 

Significant blood loss is a medical emergency and potentially life-threatening. Call 911 or visit the nearest emergency room if you experience any of the following symptoms:

• Coughing up more than a few teaspoons of blood 
• Bloody urine or stool
• Chest pain 
• Dizziness or lightheadedness
• Fever
• Severe shortness of breath 
• Weakness or unusual, unexplained fatigue
• Unusual sweating 
• Rapid heart rate 

Diagnosis

When you visit your healthcare provider, they will ask about your symptoms, review your medical history, and perform a physical examination. During your visit, they may ask:

• When your cough started and when you first noticed blood in your mucus
• Whether anything triggers coughing or the appearance of blood (e.g., lying down, cold temperatures, physical activity) 
• How much blood you cough up at a time/per day
• Whether you have other symptoms (e.g., fever, chest pain, weight loss) 
  

During the physical examination, your healthcare provider will listen to your breathing and heart rate with a stethoscope and closely examine your neck and legs to look for signs of bulging blood vessels or swelling (edema). They will also examine your mouth and nose for signs of injury or bleeding. They may ask you to cough to see if any blood comes up.

Based on the findings from the physical examination, your healthcare provider may order diagnostic tests to determine what’s causing the bleeding. These tests may include:

• Blood tests to measure your blood oxygen levels and complete blood count (CBC)
• Imaging tests, such as a chest X-ray or computed tomography (CT) scan, to look for abnormalities in the lungs and airways (e.g., infection, injury, tumor) 
• Bronchoscopy, which involves inserting a flexible tube (bronchoscope) through your mouth and down your throat to look at your airways 
• Pulmonary arteriography, a test that uses a special dye and X-rays to visualize how blood flows through your lungs

How to Stop Coughing Up Blood

With mild to moderate blood loss from coughing, treating the underlying cause may be enough to stop the bleeding or prevent significant blood loss. In severe cases with substantial blood loss, treatments can be used to keep your airways open and stop the bleeding. This may involve:

• Intubation: This involves placing a tube in your nose or mouth and down your throat to keep your airways open. 
• Bronchoscopy: A bronchoscope (flexible tube) allows your healthcare provider to view the airways and remove clots that may be causing bleeding.
• Bronchial artery angiography and embolization: If a major blood vessel is the source of bleeding, this procedure can close off and stop blood flow in the affected blood vessel. 
• Medication: Antifibrinolytic medicines, such as tranexamic acid, help stop bleeding and prevent further blood loss. 
• Surgery: In cases where other measures (e.g., bronchoscopy, medications) do not stop the bleeding, emergency surgery may be necessary. 

If a heavy, violent cough is the cause of coughing up blood, here are things you can do at home that may help soothe your airways. These include: 

• Cough suppressants: Over-the-counter cough medicines may help suppress a heavy cough. These medicines are not safe for everyone, so check with your healthcare provider before using them. 
• Drink water: Staying hydrated can help keep mucus thin, making it easier to cough it up without irritating your airways.
• Avoid smoking and other irritants: Smoking and other environmental irritants, such as dust, powders, and chemicals, can worsen a cough.

Complications and Prognosis

In cases of massive hemoptysis that cause heavy bleeding and significant blood loss, possible complications include:

• Respiratory distress or failure: Severe, large-volume blood loss can obstruct the airways, leading to difficulty breathing, and may require oxygen therapy or mechanical ventilation to help you breathe and prevent death.
• Aspiration pneumonia: Inhaling blood into the lungs can trigger this type of pneumonia, 
• Anemia: Significant blood loss, especially prolonged or recurrent blood loss, can lead to anemia, causing fatigue, weakness, and shortness of breath. 
• Hypovolemic shock: In rare cases, massive hemoptysis can lead to life-threatening blood loss and shock, which is life-threatening without treatment. 
  

In non-emergency cases, the prognosis for people experiencing hemoptysis depends on the cause of coughing up blood and the severity of the condition. Generally, early diagnosis and treatment for the underlying condition can help improve long-term outcomes. 

A Quick Review

Coughing up blood, though alarming, isn’t always a sign of a serious problem, but it does warrant medical attention. Possible causes of coughing up blood range from acute respiratory infections to chronic conditions, such as lung or heart disease. While minor blood loss does not require immediate treatment, significant blood loss can be life-threatening and requires emergency care. 

See a healthcare provider if you’re coughing up blood, even small amounts. Early diagnosis and treatment are key to managing the underlying cause and preventing complications. Your provider can determine the cause and recommend the most effective treatment.