You Ask , They Answer
Q
: Is coughing up blood always a sign of a serious condition ?
Haemoptysis refers to the coughing up of blood from a lung source , below the vocal cords or glottis . To make the right diagnosis , it is important to first differentiate haemoptysis from mimickers , e . g ., vomiting of blood from the gastrointestinal tract ( haematemesis ) or bleeding from the gums and nasal passages .
Haemoptysis can be a common symptom . In a study of patients in primary care , approximately one in 1,000 patients per year experienced it , but these cases tend to be mild .
On the other end of the spectrum , massive haemoptysis can be life-threatening . It is less common and occurs in 5-15 percent of patients presenting with the condition . Generally , bleeding rates more than 100 ml of blood ( 1 / 3 cup ) over one hour or 500 ml in 24 hours are considered massive . Patients with lower cardiopulmonary reserves are at higher risk , even with lower bleeding rates ( 50 ml / hour ).
Q
: What are the common causes ?
A
: Haemoptysis has numerous causes as the bleeding can arise from different regions in the lung : a . Tracheobronchial airways b . Pulmonary parenchymal ( lung tissue ) c . Pulmonary vessels Common causes include acute bronchitis , pneumonia , tuberculosis , lung cancer , and chronic lung disease , such as chronic bronchitis and bronchiectasis .
Less common causes include the presence of an aspergilloma ( a fungal ball , within a chronic lung cavity ), fungal infections in immunocompromised patients , and pulmonary embolism .
Q
: Should people who cough up blood see a doctor or go to the Emergency Room ( ER )?
A
: They should see a doctor to determine the underlying cause for targeted treatment . Most cases are mild and self-limiting . However , if there are features and risk factors for an underlying cancer or chronic lung disease , further lung imaging and examination with scopes might be needed .
If the haemoptysis is massive , patients will have to proceed to the ER . Massive haemoptysis can be life-threatening because the windpipe can become obstructed , resulting in respiratory failure or cardiac arrest .
The patients who are at higher risk of asphyxiation from massive haemoptysis are usually older and have weaker physical and cardiorespiratory reserves due to underlying comorbid diseases , e . g ., heart disease , cancer , or stroke .
Q
: Are there treatments to reduce the risk of coughing up blood ?
A
: The treatments target the underlying causes , which are varied . In patients with chronic lung disease , e . g ., bronchiectasis and chronic bronchitis , vaccinations and longterm macrolide therapy might prevent lung infections or infective exacerbations .
If patients are hospitalised , intravenous or nebulised tranexamic acid can be used to reduce bleeding ; cough suppressants and antibiotics can reduce coughing .
In massive haemoptysis , emergency procedures might be required , such as intubation to secure the airway , a bronchoscopy , and the use of an endobronchial blocker to seal off the bleeding lung segment .
As the bleeding source is typically from hypertrophied bronchial arteries , bronchial arterial embolisation is often the definitive emergency treatment . An arteriogram is first performed to locate the bleeding bronchial artery which is then blocked off with various endovascular agents , e . g ., a gelatin sponge , polyvinyl alcohol particles , microspheres , or even metallic coils , to stem the bleeding . The success rates range from 60-90 percent , but the risk of recurrent bleeding can be as high as 30-50 percent in patients with an aspergilloma or lung cancer , respectively .
Dr Lim Hui Fang
Dr Lim Hui Fang is a specialist in respiratory medicine and intensive care medicine at The Respiratory Practice , Farrer Park Hospital . She is also a visiting senior consultant at National University Hospital and Adjunct Assistant Professor at the National University of Singapore .
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12 ISSUE 2 | 2023 GlobalHealthAsiaPacific . com