From the Research
Hemoptysis is not a commonly reported side effect associated with Humira (adalimumab), and its frequency is estimated to be less than 0.01% of patients, based on clinical data and post-marketing surveillance 1.
Causes and Evaluation of Hemoptysis
The causes of hemoptysis are varied and include acute respiratory infections, cancer, bronchiectasis, and chronic obstructive pulmonary disease, among others 2, 3, 4, 1, 5. When evaluating a patient with hemoptysis, it is essential to determine the severity of bleeding and stability of the patient, and to rule out pseudohemoptysis, which is blood that originates from nasopharyngeal or gastrointestinal sources 2.
Diagnostic Approach
The diagnostic approach to hemoptysis typically involves chest radiography as the initial test, followed by computed tomography (CT) with or without bronchoscopy in patients with massive hemoptysis, abnormal radiographic findings, or risk factors for malignancy 2, 3, 1, 5. CT angiography is a useful tool in identifying the source of bleeding and guiding treatment 3, 1.
Management of Hemoptysis
The management of hemoptysis depends on the severity of bleeding and the underlying cause. Mild hemoptysis can often be managed on an outpatient basis with close monitoring, while massive hemoptysis requires immediate medical attention and may involve bronchial artery embolization or surgery 3, 1.
Humira and Hemoptysis
In patients taking Humira, hemoptysis should prompt immediate medical evaluation to rule out serious underlying conditions such as tuberculosis (TB), which is a known risk with TNF inhibitors, or other pulmonary infections, malignancies, or vasculitis 1. Before starting Humira, patients should be screened for latent TB, as the medication can reactivate dormant infections. Any patient on Humira who develops hemoptysis should discontinue the medication and seek immediate medical attention for proper diagnostic workup, including chest imaging and possibly bronchoscopy. Some key points to consider in the management of hemoptysis in patients taking Humira include:
- Immediate medical evaluation to rule out serious underlying conditions
- Discontinuation of Humira and initiation of diagnostic workup, including chest imaging and possibly bronchoscopy
- Screening for latent TB before starting Humira
- Consideration of bronchial artery embolization or surgery in cases of massive hemoptysis
- Close monitoring and follow-up to prevent recurrence and ensure proper treatment of the underlying cause.