Coughing up blood, also called ‘hemoptysis’ medically, is when people cough up blood (by itself) or blood mixed with mucus. When mucus has blood in it, it can have streaks of blood, or the mucus can turn red or pink. Coughing up blood can happen in adults and older children, but it is uncommon in young children.

When a person coughs up blood, it means the blood is coming from their airways or lungs. Bleeding from the nose or stomach can look like coughing up blood, but it is not the same.

If people cough up a lot of blood, it is called "massive hemoptysis” and this can be a medical emergency.

In adults, there are many causes of coughing up blood, but the most common causes are; Bronchitis which is the inflammation and usually associated with damage of the bronchi(The bronchi are the tubes that carry air into the lungs),Infections of the lungs such as pneumonia Tuberculosis, and fungal infections of the lungs. Bronchiectasis, a condition in which the airways are damaged and enlarged which easily allows bacteria and mucus to build up in the airway leading to blockages and infections in these airways.The commonest cause of bronchiectasis is lung infection, commonly bacterial and viral infections. Cancer that affects the bronchi or airways also can lead to coughing up blood.

In children, the most common causes of coughing up blood are; An infection of the bronchi, airways, or lungs, having an object or piece of food stuck in the airway. The object might be stuck for days or weeks before a child starts coughing up blood. Bronchiectasis is rare in children, and is is usually caused by a condition which some children are born with called "cystic fibrosis,” which causes thick mucus to build up in the lungs leading to frequent lung infections.

Coughing blood isn’t a normal thing and one should seek medical advice if they notice blood in their sputum. Coughing out a lot of blood (up to 1 cup or more) or having difficulty in breathing should be considered a medical emergency and immediate medical care should be sought.

Diagnosing the cause of coughing blood is made through taking a proper history of the patient and the complaints, physical examinations and laboratory with imaging investigations done to confirm the cause.

Investigations maybe done such as; a chest X-ray, Laboratory tests which might include blood tests or tests on a sample of the mucus coughed up, a bronchoscopy which is a procedure in which a thin flexible tube onto which a tinny camerais attached(called a "bronchoscope”) to look inside your airways. A chest CT scan can be done too.

Treatment for coughing up blood depends on the particular cause and the severity of the disease.

If your symptoms are mild and happen only with a common cold, you might not need treatment.

Cough medicine to keep you from coughing, antibiotics for bronchiectasis and bronchitis can be prescribed. If one is found to be suffering from Tuberculosis, treatment for TB is given and this should be taken as prescribed to prevent drug resistance. Quitting cigarette smoking is advised to alleviate these symptoms and prevent long-term diseases such as cancers of the lungs, among others.   

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital

iangashugi@gmail.com