Hemoptysis

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Questions to Ask Your Pulmonary Care Team
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Treatment

Treatment for hemoptysis depends on the cause and the quantity of blood. Infrequent, mild hemoptysis usually does not require specific, immediate treatment, but it should always be thoroughly investigated in case the underlying disorder is life threatening. There is no way to predict whether a patient with mild hemoptysis will experience massive, life-threatening hemoptysis, so it is very important that the underlying cause be determined and treated.

Massive, or major, hemoptysis is a medical emergency. Death can result, usually from asphyxiation (impaired gas exchange in the lungs, leading to a lack of oxygen and excess of carbon dioxide in the body). In massive hemoptysis, steps are usually taken to localize the source of the bleeding, control the bleeding, and assure that the patient is able to breathe.

Some methods of controlling bleeding include: Bronchial artery embolization, surgical resection, and bronchoscopic laser therapy.

For mild or moderate hemoptysis in patients who have chronic bronchitis, bronchiectasis, or tuberculosis, treatment usually involves antibiotics. For bronchogenic carcinoma, treatment depends on the stage of the cancer.

In the 20% to 30% of cases that do not have an indentifiable underlying cause, treatment should be fairly conservative and the hemoptysis carefully monitored for at least 2 or 3 years after the initial diagnosis. In 90% of patients who have a normal chest x-ray and bronchoscopy, the hemoptysis usually disappears within 6 months.

For chronic hemoptysis, the treatment is dependent on the symptoms and causes. Sometimes all that is necessary is switching antibiotics. In other instances, more aggressive treatment may be necessary.

Bronchial artery embolization involves injecting substances into the bloodstream to stop blood flow. It is a proven technique for stopping life-threatening massive hemoptysis and can have beneficial long term effects as well, although it is not always successful and is not without complications.

Surgical resection is the surgical removal of the abnormal tissue causing the hemoptysis. It is often recommended as an early treatment for hemoptysis caused by aspergilloma (see Aspergilloma).

Bronchoscopic laser therapy involves using laser therapy during a bronchoscopy to remove tumors and lesions or widen airways.

All of these techniques have proved beneficial in controlling or curing hemoptysis due to bronchiectasis or other inflammatory disorders. The pros and cons of the various techniques depend on the skill of the doctor performing the procedure and the availability of the necessary equipment. The patient should discuss the various procedures thoroughly with their primary physician, thoracic surgeon, and radiologist.

Follow-up

Follow-up depends on the cause and severity of the hemoptysis. Patients should discuss the need for return appointments with the physician.

If, for example, a mild case of hemoptysis due to bronchitis, TB, or bronchiecstasis becomes chronic after treatment with antiobiotics, a different antibiotic may be needed or more agressive treatment may be necessary.

If the underlying cause of the hemoptysis is unknown (cryptogenic hemoptysis), the hemoptysis should be carefully monitored for 2-3 years following initial treatment. This monitoring may involve routine chest x-rays.

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