What Does Coughing Up Blood Mean

What does coughing up blood mean - Under coughing up blood (Hemoptysis) is defined as the expectoration of blood or bloody colored sputum. Of massive Hemoptysis is when the coughed quantity of pure blood reached more than one hundred to 300 milliliters a day. 300 Milliliter is roughly equivalent to the content of about two cups.
What Does Coughing Up Blood Mean

It is shocking when suddenly blood on a white handkerchief. First of all, between bleeding from the nose and throat or the gastrointestinal tract, as well as from a hemorrhage from the lungs hardly be distinguished. Also, during heavy nosebleeds, or bleeding from the stomach can be coughed up swallowed blood. This apparent coughing up blood also pseudo-hemoptysis. Therefore, Sufferers do not need to go out immediately from the worst case of lung cancer, however, an immediate clarification from the doctor is required. But mostly the trigger of a blood cough a lot less threatening and a good way to treat it.

Coughing up blood is a Symptom of a Disease

Coughing up blood is not a stand-alone disease. Behind the Symptom of coughing up blood a triggering illness is hidden. Therefore, the signs of the disease when coughing up blood in the first line by the amount of blood and the underlying disease. Coughing up blood, in the medical jargon as Hemoptysis referred to, Concerned mostly scared of them, even if only small amounts of blood are coughing. Great excitement and anxiety, therefore, are often typical symptoms of coughing up blood.

Danger from hemorrhage in other lung sections

The bleeding does not endanger the patient in the rule, by the loss of blood. Although the excreted amounts of Blood in the case of massive hemoptysis can be significant, they can be easily overestimated, because the blood is often mixed with mucus. The danger arises from the fact that blood runs in others, the bleeding is not affected in lung sections, and thus the breathing may be adversely affected. How much the breathing is impaired depends on the strength of the bleeding.

With a slight bleeding (less than 100 milliliters a day) will be alarmed, the Concerned, but due to the bleeding in itself is not a deterioration of the efficiency of his lungs. This is especially true when there is no chronic lung disease present. In the case of a chronic lung disease, for example, in the case of severe chronic Bronchitis, can interfere with however, small amounts of Blood, the respiration significantly and will lead to a hazard.

Bleeding worsens respiratory function

Stronger bleeding leads to a reduction of functioning lung tissue, a restrictive (reduced lung volume). The respiratory function of the lung, the gas exchange is decreased, The lungs can no longer afford the absorption of oxygen and release of carbon dioxide (CO2) in full. Massive bleeding can obstruct the breathing in such a way that they are lethal. In the case of massive bleeding, the amount of pure blood is coughed up, every day more than 100 to 300 milliliters (equivalent to about the contents of the two cups).

Purulent sputum in inflammatory diseases: In the case of infections, the sputum may be purulent, fever may occur and the patients may suffer from a General feeling of illness and weakness.
See also: Coughing Up Blood with Mucus
Weight loss as another Symptom of tumors: Malignant diseases often due to a weight loss are noticeable, in addition to fever and night sweat, the disease accompany. Is beads of coughing up blood by tumors (metastases) in other tumors, due to, in some cases, cancer known.

Shortness of breath often accompanies cardiovascular diseases

If cardiovascular disease is the cause of the bleeding in the lung (for example pulmonary embolism, heart failure), chronic lung disease already exists, or the bleeding is so strong that other lung sections thus affected, can shortness of breath occur as additional signs of the disease with coughing up blood.

In the case of heart diseases the heart is expressed weakness may be due to water retention from the inlay in the legs (Edema). Unilateral leg swelling, such as a thrombosis, typically, deflects the suspicion of a pulmonary embolism because venous thrombosis is a common cause of pulmonary embolism: a Thrombus (blood clot) in the leg vein can break loose and passive with the flow of blood up into the pulmonary vessels are transported, where it comes to the closure of a vessel (embolism).

Further bleeding is typical for blood clotting disorders: A blood clotting disorder, the blood to cough other bleeding additional symptoms may, such as, for example, bleeding gums, nosebleeds, or bleeding from the intestine.

Coughing up blood: not only to tumors as possible cause

The causes of hemoptysis can be classified into different groups: tumors, inflammatory diseases and cardiovascular diseases. Only rarely do other disorders are the cause. There are a variety of diseases that can lead to a cough up blood. However, certain diseases are far more common than others. Basically, the causes can be classified into four different groups:
  • Inflammatory diseases
  • Tumors, also called neoplasms (benign or malignant)
  • Cardiovascular Diseases
  • Other (rare) causes

What Causes Coughing Up Blood?

In principle, coughing up blood (Hemoptysis) occurs by the following mechanisms: increased vulnerability of the bronchial mucosa with inflammation, Ingrowth of tumors in vessels, increase in pressure in the pulmonary vessels (for example, in the case of cardiovascular diseases), blood clotting disorders and direct injury, for example, due to a car accident.

Inflammatory Diseases

Among the inflammatory disorders, which may lead to coughing up blood, among other things, acute and chronic Bronchitis. Also, the inflammation of the lungs (pneumonia), a suppurative focus in the lungs (lung abscess) and tuberculosis can cause coughing up blood. In addition to the infectious pathogen-induced inflammatory lung cough to name the autoimmune diseases in which the immune system against body's own tissue, which also leads to an inflammatory reaction of the disease as a rare cause of blood.

Inflammatory diseases can cause permanent extensions or Outgrowths of the bronchi (bronchiectasis), which lead to coughing up blood. In bronchiectasis the bronchial mucus accumulates, forming a particularly good breeding ground for infectious pathogens: bronchiectasis leads to inflammation caused by infection.

The inflammatory response causes the bronchial mucosa to be particularly relaxed, well-supplied with blood and is particularly sensitive: There may be skin in the case of a strong cough, but also spontaneously to injuries of the mucous membrane, from which it is bleeding.


In the case of the coughing up blood (Hemoptysis) leading to tumors, or neoplasms, the malignant diseases predominate. In the first place, the lung is cancer (bronchial carcinoma). But also lung metastases, i.e., metastases from cancers of other organs, and other malignant tumors may cause coughing up blood. As examples for possible tumors in the lungs are called:
  • Bronchial carcinoid: a special form of a malignant tumor in the lungs.
  • Kaposi's sarcoma: It occurs mostly in case of immunodeficiency (HIV disease, AIDS) and is characterized by nodules-like, bluish-purple tumors in the skin or mucous membranes (mouth, intestines, and bronchi).
  • Lymphomas: diseases that cause enlarged lymph nodes. Although there are also benign lymph node enlargements, are usually referred to more or less malignant diseases of the lymphatic system (lymphocytes, lymph nodes, spleen, bone marrow) lymphoma. The lymph nodes of the lungs are involved, blood can occur cough.
  • A rare cause of hemoptysis is the bronchial adenoma, a benign Tumor of the respiratory tract.

In the case of tumors and malignant diseases tumor tissue in blood vessels ingrowth can. If the injured blood vessels in this way, connection to the bronchi get, it comes to coughing up blood.

Cardiovascular Diseases

In the case of cardiovascular diseases the following disease among some of the images as the cause of coughing up blood (Hemoptysis) pulmonary embolism, heart failure (congestive heart failure), heart defects (in particular, mitral stenosis = narrowing of the heart valve between the left atrium and the left ventricle of the Heart) and high blood pressure in the lungs (pulmonary hypertension).

The common mechanism of all these diseases is vessels can lead to a backflow of blood in the Lungs. The backlog leads to an increase in pressure in the vessels of the lungs. The increase in pressure can lead to smaller blood vessels to leakage through the blood in the lungs can escape, which then leads to coughing up blood.

Blood Coagulation Disorders

Disturbances of blood coagulation can cause coughing up blood. These disorders may be caused be congenital, such as, for example, in the case of the blood disease (hemophilia), but also – intentionally or unintentionally – through drugs. So, it is intended in the case of administration of Heparin and Coumarins in the inhibition of blood coagulation. Often coughing up blood, especially if, in addition, an infection of the respiratory tract, with increased vulnerability of the mucosa. Acetylsalicylic acid (Asa) can impair the clotting of blood in a small but clinically meaningful extent.

No matter whether the blood coagulation congenital disorders or by drugs are caused, they can cause the same mechanism to coughing up blood: every Day, especially on the mucous membranes to minor injuries, in which small blood vessels are affected. We do not notice the injuries, but because of the blood clotting sealed these violations immediately, so that no blood can escape in visible quantities. Inflammation, for example, by infections, increase the likelihood of such tiny injuries because of the sensitivity of the inflamed tissue is greater. In the case of disorders of blood clotting to seal the injury takes place is delayed or not at all: it can also lead to bleeding from the bronchial mucosa, which are associated with coughing up blood.

Other Causes for Coughing Up Blood (Hemoptysis)

Also, medical interventions, for example, the collection of samples may lead to coughing up blood. Here two methods are mentioned: the direct puncture of the limited pathological changes (herd) in the lung through the wall of the chest with a long needle. Stronger or threatening bleeding from a sampling point are very rare. Minor bleeding, however, are more common and may lead to coughing up blood. The second method is the Lung endoscopy (bronchoscopy): following a lung mirroring it often leads to fine traces of blood in the sputum. This is due to the fact that the hose, which will be introduced at the time of bronchoscopy in the bronchial tubes, causing minor injuries to the bronchial mucosa.

Other causes of trauma (injury) to the chest, such as in car accidents impact on the steering Wheel or knife stab wounds. Also, the ingestion of foreign bodies (needles, coins, dental crowns, and other) may lead to coughing up blood. In all cases, the vessels can be in the lungs or bronchial mucosa are injured and coughing up blood cause. Other, rarer causes for coughing up blood abnormalities in the lungs are vascular. From such vascular defects, it can bleed at any time, spontaneously, possibly accompanied by coughing up blood.

Coughing Up Blood: Tests at The Doctor's

In the case of hemoptysis, the Patient from the doctor to the medical history asked (medical history). Depending on the existing signs of the disease and the suspected diagnosis in addition, various investigations are carried out.

The doctor will ask the patient when coughing up blood (Hemoptysis) just the cough itself, as well as to pre-existing conditions and concomitants. The physical exam gives more clues as to the possible disease. It is essential, first, that the Patient describes to the doctor the medical history (anamnesis). It is the starting point for the subsequent investigations. For this purpose, the doctor asked under what circumstances the coughing up blood occurs, since when the coughing up blood and how much blood is coughed up. In addition, a special importance is attached to the following details:
  • What pre-existing conditions and accompanying complaints? Here are the symptoms of an infection (for example fever, shortness of breath, weight loss) are important clues for the diagnosis.
  • What are the risk factors such as Smoking habits are there?
  • What are the medications to be taken?
The physical examination can narrow the suspected diagnosis already. Special attention is put the doctor on the circulation, and paleness of the skin, pulse, blood pressure and heart sounds. Very important also, listening to (auscultation) of the lung. Apart from the fact that the breath sounds can be indicative of the disease, the doctor when listening to any well on which side of the lung the bleeding is localized, because it is often the person Concerned is not possible, this sure.

The results of the survey and the physical examination to corroborate the suspected diagnosis of a doctor or a close, at least, the number of possible causes and determine the further studies. Remains unclear, whether the bleeding from the lungs or the nose and throat or the stomach comes tract, may be a Reflection of the pharynx and larynx, respectively, a gastroscopy is necessary.

X-Ray Examination

The x-ray examination of the chest is usually essential, it is of great importance. For one, they might provide valuable information on the extent of the hemorrhage; and, on the other hand, many diseases, coughing up blood (Hemoptysis) is associated with morbid, some very typical changes of the x-ray image. The x-ray shows recording changes in a pneumonia, a lung abscess, tuberculosis, and many malignant diseases or heart diseases. A normal x-Ray is frequently associated with pulmonary embolism, a very small or centrally-seated tumors, bronchiectasis, ingestion of foreign bodies, or blood clotting disorders. Another imaging method using x-ray computed tomography. By the x-ray image of the chest is made in the finest layers. With this method, even very small pathological processes in the lungs, the bronchi, the vessels, and all the other in the chest can be found in important structures and be associated with it.


The Mirroring of the lungs (bronchoscopy) is a ground-breaking measure for the diagnosis and, where appropriate, for the treatment of a bleeding episode. During the bronchoscopy is trying to locate the source of bleeding. However, this can be difficult, if the bleeding has already stopped. But even if the bleeding is very strong, can not be determined its origin often, because for the doctor, and the view is obscured by the bleeding. The localization of the bleeding is important; at least one must determine on which side of the lung (left or right), it bleeds For a possible need for emergency surgery, the surgeon needs to know exactly where the source of bleeding is located. Bronchoscopy can also be used for therapy of bleeding: During bronchoscopy, for example, blood can be given medication directly into the bronchial system. Also can be breastfed during bronchoscopy, bleeding from tumours, by electric current or Laser is used light, with which the blood tissue literally is overcooked.

A more in-depth diagnosis with bronchoscopy and computed tomography, for example, is then not strictly necessary, if it is a single Episode of coughing up blood, the x-ray is unremarkable, a probable cause is present (for example, acute Bronchitis), and in addition, risk factors such as Smoking history and increasing age are missing. Initially, it may be the treated underlying disease, and wait and see if in the further course again coughing up blood occurs. A final bronchoscopy and/or computed tomography is recommended, nevertheless, usually from security.

Additional Studies

May be additional, very different studies are still necessary. This can be:
  • Lung function investigation
  • Blood gas analysis
  • ECG (electrocardiogram)
  • Ultrasound examination of the heart
  • Heart catheter investigation

Therapy: Breastfeeding the Bleeding

The treatment depends on the severity of the coughing up blood. In the case of massive hemoptysis must be trying to stop the bleeding. In the treatment a distinction must be made between moderate and massive hemoptysis. It is only small amounts of Blood and the person Concerned does not appear to be endangered thereby, no symptomatic measures are necessary first, that is to say, it doesn't have to be against the Symptom of coughing up blood made. It is important to find the cause and treat this if possible. Bed rest is useful is the magnitude of the blood-cough is uncertain, or increasingly, should be included in the Affected stationary. The administration of soothing drugs can be useful.

Since a persistent cough to bleeding, it is sometimes useful, the cough medication to suppress. It is administered, then so-called Antitussives (e.g. codeine), the cough reflex in the cough center of the brain. The Inhalation of certain substances can sometimes, to stop bleeding or to reduce.

Hemostasis With the Help of the Bronchoscopy

The bleeding is massive or the Patient in his breathing is greatly impaired (such as in the case of an existing lung disease), as it applies in the first place, to bring the bleeding to a standstill and to protect the areas, bleeding of the Lungs. In case of a continuing bleeding, the blood would run in the non-bleeding lung areas, and the breathing is still more affecting, because of the gas exchange would be hampered bubbles in the fine lung. Hemostasis can be attempted by a Lung endoscopy (bronchoscopy).

In the case of very severe bleeding, it is necessary, during the bronchoscopy, a breathing, the breath hold and that the oxygen supply to the body. For this you can use a breathing tube, a thin, flexible plastic tube that is inserted through the mouth into the trachea, together with a flexible bronchoscope. It is also a rigid bronchoscope can be used, in which a rigid metal tube through the mouth into the lungs is introduced. Through the bronchoscope, the Central breath can then can paths will be considered. During the bronchoscopy, blood can be still be given medication directly into the bronchial system, and bleeding tumors can be coagulated with laser light or electricity (overcooked).

What Does Coughing Up Blood Mean: Operation

In the case of repeated bleeding, clearly localizable bleeding and in the case of certain diseases (for example, lung cancer, lung abscess, vascular malformations), it can be a surgery with removal of the source of bleeding is necessary. Such a case may, for instance, occur in the case of lung cancer, lung abscess, or vascular malformations. (A known Vascular malformation is a sponge of Blood. Similar deformities can occur in addition to the skin in the body and not be noticed at birth, but later, randomly, or due to a hemorrhage).

Immediate surgery will be done only in very emergency situations. Before surgery is attempted to clarify the cause and localization of the bleeding and to bring the patient in a stable condition with respect to the function of heart, circulation and respiration.

Obliteration of Vessels

A special form of treatment is sclerotherapy of blood vessels, which form a recurring and for the patient-threatening source of bleeding. Such vessels are usually extended and can be vessels detected by means of an angiography (visualization of blood in the x-ray image after injection of contrast medium). For this purpose, under x-ray control, a catheter can be introduced selectively into the blood vessel, to a sclerosing agent injection. As a sclerosing agent used is preferably small spirals, or other foreign body, wedged at the point where it brings you, in the vessel and a blood clot for a permanent closure of the blood vessel and to the Cessation of the bleeding.

Treatment of the Underlying Disease

The cause is known, treat the underlying disease by means of targeted measures. Antibiotics are used for infections,surgery, chemotherapy, or radiation therapy for malignant diseases. The administration of coagulation products with blood clotting disorders, a drug treatment for heart failure in question.

Healthy lifestyle lowers risk for coughing up blood

What does coughing up blood mean - It is not possible, coughing up blood directly prevent. A healthy lifestyle lowers the risk of the disease. Because of the coughing up blood is usually a Symptom of another underlying disease, you can not prevent it directly. A healthy lifestyle lowers the risk to get a disease that leads to coughing up blood. In the first place the renunciation of the Smoking is to be mentioned here.