SYMPTOMS

What is hemoptysis?

Hemoptysis refers to the process of expelling blood from any part of the respiratory tract below the larynx (typically the trachea, main bronchi, and smaller bronchial branches within the lungs) through the mouth. However, oral bleeding is not necessarily hemoptysis—it could also stem from nasal, dental, throat, or gastric bleeding. Therefore, when diagnosing, bleeding from the teeth, gums, nasal cavity, throat, or digestive tract must first be ruled out. Only bleeding from the trachea, bronchi, or lungs that is expelled via the respiratory tract qualifies as hemoptysis. In many cases, patients cannot determine the source of bleeding themselves and should seek professional medical assistance at a hospital.

TREATMENT

How to alleviate or manage hemoptysis?

• First, the patient and family members should remain calm. Minor bleeding is usually not life-threatening, and seeking medical attention promptly is sufficient.

• After hemoptysis occurs, coughing should be minimized. When small blood vessels rupture, small blood clots often form at the rupture site to stop the bleeding. Vigorous coughing can dislodge these clots, leading to renewed bleeding. Temporary cough suppressants, such as Pholcodine Syrup (its main ingredient is codeine, a potent central cough suppressant), can be taken to temporarily relieve coughing. However, in cases of massive hemoptysis (≥500mL in 24 hours or bleeding rate ≥100mL/hour), using strong central cough suppressants may cause blood clots to block the airway, leading to suffocation and life-threatening conditions. Therefore, cough suppression should not be considered in cases of massive hemoptysis.

• For moderate to massive hemoptysis, the patient should quickly assume a left lateral position and cough out the blood to prevent it from flowing into the trachea and causing suffocation. The lungs consist of two sides: the left lung accounts for 45% of respiratory reserve, while the right lung accounts for 55%. After hemoptysis occurs, some blood may inevitably flow into the lungs. The left lateral position encourages blood to flow to the left side, keeping the right bronchus relatively clear. This ensures at least the right lung's respiratory function is preserved, buying time for further treatment. In such cases, emergency services (120) should be called immediately, and the patient should avoid moving to prevent worsening bleeding or severe consequences.

• If hemoptysis occurs, it often indicates a serious condition, so prompt hospital treatment is necessary to determine the underlying cause.

DIAGNOSIS

Under what circumstances should one seek medical attention for hemoptysis?

Generally, if hemoptysis occurs, prompt medical attention is necessary. The lungs are vital respiratory organs, and coughed-up blood can easily be aspirated into the lungs or major bronchi, leading to suffocation and potentially fatal consequences. For minor hemoptysis (less than 100ml, roughly the volume of a wine glass), it may be acceptable to visit the hospital at a convenient time. However, in cases of significant hemoptysis, blood can quickly obstruct the trachea or bronchi, causing suffocation. A healthy person can survive 7 days without food and 3 days without water, but just 5 minutes of suffocation can result in permanent brain damage or death.

POTENTIAL DISEASES

What are the possible causes of hemoptysis?

• Bronchial diseases: Common conditions include bronchiectasis, bronchial lung cancer, bronchial tuberculosis, and chronic bronchitis. The main causes are inflammation and tumors damaging the bronchial mucosa and capillaries at the lesion site, leading to submucosal vascular rupture and bleeding.

• Pulmonary diseases: Common conditions include tuberculosis, pneumonia, and lung abscess. The amount of bleeding is related to the severity of the lesion. When the lesion invades small blood vessels formed by branches of the pulmonary artery, it can lead to massive hemoptysis, which is life-threatening.

• Circulatory system diseases: Relatively common conditions include rheumatic heart disease and congenital heart disease in advanced stages with pulmonary hypertension, which can also cause hemoptysis. The main cause is pulmonary congestion and rupture of bronchial mucosal capillaries.

• Others: Some hematologic diseases (such as leukemia, aplastic anemia, hemophilia, thrombocytopenic purpura, etc.) and infectious diseases (such as hemorrhagic fever, leptospirosis, rheumatic fever, etc.) may also present with hemoptysis.