“Ask Dr. HKSH” - Coughing Up Blood

Dr. LAM Chung Mei, Jamie

Specialist in Respiratory Medicine

Q1. Does coughing up blood mean lung cancer?

There are many other reasons for coughing up blood. It is not necessarily caused by lung cancer. Other lung and chest conditions may also make one cough up blood.

Q2. Is coughing up blood the same as vomiting blood? What diseases are associated with it?

When one is coughing up blood, the blood usually comes from the upper respiratory tract or the lungs. In case of vomiting blood, the blood originates from the oesophagus or stomach. One often spits up blood clots or blood-streaked sputum while coughing up blood. It may be associated with pneumonia, pulmonary tuberculosis, cancer, or infection of the upper respiratory tract. Other possible causes are foreign body obstruction of the respiratory tract (choking), throat injury caused by coughing, or trauma to the upper respiratory tract from coughing.

Q3. A family member has been coughing for a long time. He/she has previously suffered a throat injury due to coughing, and occasionally the sputum is blood-streaked. Should we seek medical consultation?

Throat injury caused by coughing only leads to short-term damage, and should heal within a short period. It is rarely caused by repetitive coughing. If blood-streaked sputum persists for a long time, it may be related to other lung and chest diseases. Those who keep coughing up blood for a long time may have bronchiectasis or pulmonary tuberculosis. They should seek medical attention as soon as possible.

Q4. Is coughing up blood immediately life-threatening? Does it require medical attention right away?

Depending on blood amount and concentration, coughing up blood can be immediately life-threatening. If pulmonary blood vessels rupture and cause massive bleeding, one may have difficulty breathing or even be suffocated due to blood accumulation in the lungs. In such cases, medical attention should be sought immediately.

Q5. How is coughing up blood diagnosed and treated?

If one presents with coughing up blood, imaging investigations are first arranged to locate the bleeding site, assess blood loss volume, and determine the extent of lung involvement. Sputum samples will then be sent for laboratory tests to identify the cause.

To stop bleeding, doctor may perform endoscopic haemostasis with bronchoscopy, or even surgery in severe cases. Other new techniques include X-ray‑guided minimally invasive procedures, which achieve haemostasis by blocking the bleeding blood vessel in the lungs with a catheter.