Coughing up blood (blood in phlegm)

Swartz MH. The chest. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Coughing up blood

Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract). Hemoptysis is the medical term for coughing up blood from the respiratory tract.

Considerations

Coughing up blood is not the same as bleeding from the mouth, throat, or gastrointestinal tract. Blood that comes up with a cough often looks bubbly because it is mixed with air and mucus. It is most often bright red, although it may be rust-colored. Sometimes the mucus contains only streaks of blood. The outlook depends on what is causing the problem. Most people do well with treatment to treat the symptoms and the underlying disease. People with severe hemoptysis may die.

Causes

• Blood clot in the lung
• Breathing food or other material into the lungs (pulmonary aspiration)
• Bronchoscopy with biopsy
• Bronchiectasis
• Bronchitis
• Lung cancer
• Cystic fibrosis
• Inflammation of the blood vessels in the lung (vasculitis)
• Injury to the arteries of the lungs
• Irritation of the throat from violent coughing (small amounts of blood)
• Pneumonia or other lung infections
• Pulmonary edema
• Systemic lupus erythematosus
• Tuberculosis
• Very thin blood (from blood thinning medicines, most often at higher than recommended levels)

Home Care

Medicines that stop coughing (cough suppressants) may help if the problem comes from heavy coughing. These medicines may lead to airway blockages, so check with your health care provider before using them.

Keep track of how long you cough up blood, and how much blood is mixed with the mucus. Call your provider any time you cough up blood, even if you do not have any other symptoms.

When to Contact a Medical Professional

Get medical help right away if you cough up blood and have:

• A cough that produces more than a few teaspoons of blood
• Blood in your urine or stools
• Chest pain
• Dizziness
• Fever
• Lightheadedness
• Severe shortness of breath

What to Expect at Your Office Visit

In an emergency, your provider will give you treatments to control your condition. The provider will then ask you questions about your cough, such as:

• How much blood are you coughing up? Are you coughing up large amounts of blood at a time?
• Do you have blood-streaked mucus (phlegm)?
• How many times have you coughed up blood and how often does it happen?
• How long has the problem been going on? Is it worse at some time such as at night?
• What other symptoms do you have?

The provider will do a complete physical exam and check your chest and lungs. Tests that may be done include:

• Bronchoscopy, a test to view the airways
• Chest CT scan
• Chest x-ray
• Complete blood count
• Lung biopsy
• Lung scan
• Pulmonary arteriography
• Sputum culture and smear
• Test to see if the blood clots normally, such as PT or PTT

References

Brown CA. Hemoptysis. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 20.

Swartz MH. The chest. In: Swartz MH, ed. Textbook of Physical Diagnosis: History and Examination. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 13.

Version Info

Last reviewed on: 5/3/2023

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Coughing up blood (blood in phlegm)

Coughing up blood can be alarming, but isn’t necessarily a sign of a serious problem. It’s more likely to be a cause for concern the older you are, particularly if you smoke. You should see your GP as soon as possible if you cough up blood.

About coughing up blood

In up to one in five cases investigated, no cause is found for coughing up blood.

If you are coughing up blood, you may cough up:

• small amounts of bright red blood
• frothy blood-streaked sputum – sputum is saliva (liquid produced in your mouth) and phlegm (a thick liquid produced, especially when a person has a cold)

The blood is usually from your lungs.

It’s often the result of coughing for long periods or a chest infection.

Mostly, if you cough up blood, the bleeding will stop on its own.

In about five per cent of people (who cough up blood for the first time) the bleeding will be severe.

This bleeding can be life threatening. Call 999 if this is happening.

If the blood is dark and contains bits of food or what looks like coffee grounds, it may be coming from your digestive system.

This may also be a serious problem. You should go to hospital straight away if you are vomiting blood.

What to do if you cough up blood

See your GP as soon as possible if you cough up blood.

It’s particularly important to see your GP if:

• you cough up more than a few teaspoons of blood
• you also have chest pain, dizziness, fever, light-headedness or worsening shortness of breath
• you have a loss of appetite or unexplained weight loss
• there’s also blood in your urine or blood in your stools

Your GP will be able to assess whether you may have a serious medical condition that needs to be investigated and treated.

Call GP out of hours service if you can’t see your GP.

Call 999 for an ambulance or go to your nearest emergency department immediately if you’re coughing up significant amounts of blood or are struggling to breathe.

Tests that may be needed

You may be asked for a sample of your sputum so it can be checked for infection.

Other tests, such as blood tests, may also be needed.

Your GP may decide to refer you to a specialist at your local hospital.

Tests that may be carried out include a:

• chest X-ray
• more detailed scan, such as a computerised tomography (CT) scan

In some cases, further tests may be required to find out where the blood is coming from.

For example, you may have a test called a bronchoscopy.

This is where the main air passages of your lungs are examined using a tube with a camera at one end.

Common causes of coughing up blood

Don’t diagnose yourself – always leave that to a doctor.

The most common reason for coughing up blood is a chest infection.

Where a specific cause is found, the most common causes include:

• pneumonia – a swelling (inflammation) of the tissue in one or both of your lungs usually caused by an infection with a germ (bacterium or virus)
• bronchitis – an infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed (it can be caused by either a virus or bacteria, although viral bronchitis is much more common)
• tuberculosis (TB) – a severe lung infection associated with fever and sweating which can be treated with antibiotics

Sometimes a severe nosebleed or bleeding from the mouth or throat can cause blood to come out in your saliva when you cough.

Less common causes of coughing up blood

Less commonly, coughing up blood may be the result of:

• bronchiectasis – this is more likely if you’re also wheezy or short of breath
• pulmonary embolism (a blood clot in the lungs) – this usually causes sudden shortness of breath and chest pain
• pulmonary oedema (fluid in the lungs) – your sputum will be pink and frothy, and this usually occurs in people with pre-existing heart problems
• lung cancer – this is more likely if you’re over 40 and smoke
• cancer of the throat or windpipe
• taking anticoagulants – medications that help stop your blood clotting, such as warfarin or other oral anticoagulants

Sometimes, in 15 to 20 per cent of cases, no cause can be found and it never happens again.

More useful links

• How to use your health services
• Emergency department average waiting times

The information on this page has been adapted from original content from the NHS website.

For further information see terms and conditions.

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