From the Guidelines
Haemoptysis, whether blood-streaked or frank, requires prompt medical evaluation and treatment to prevent morbidity, mortality, and to improve quality of life. The management of haemoptysis depends on the severity and underlying cause of the bleeding. According to the most recent and highest quality study 1, massive hemoptysis is clinically subdivided into “clinically unstable” and “clinically stable.” In unstable massive hemoptysis, the primary focus is patient stabilization and resuscitation.
Causes and Severity of Haemoptysis
The causes of haemoptysis can range from acute respiratory tract infections, chronic obstructive pulmonary disease, malignancy, and bronchiectasis 1, to more severe conditions such as lung cancer, pulmonary embolism, and tuberculosis. The severity of haemoptysis is determined by the amount of blood, rate of bleeding, and the patient's underlying respiratory function.
Initial Management
Initial management involves stabilizing the patient, controlling bleeding, and identifying the cause through tests such as chest X-ray, CT scan, bronchoscopy, and blood tests. For patients with massive hemoptysis, bronchial artery embolization (BAE) is recommended for those who are clinically unstable 1. Bronchoscopy is used for both diagnostic and therapeutic purposes in patients with massive hemoptysis, providing information on the anatomic site and side of bleeding, nature of the bleeding source, severity of bleeding, and therapeutic feasibility 1.
Treatment Options
Treatment depends on the underlying cause and may include:
- Antibiotics for infections
- Antitussives to suppress cough
- Bronchial artery embolization for severe bleeding
- Surgery in some cases
- Bronchoscopic-guided topical hemostatic tamponade therapy using oxidized regenerated cellulose mesh for immediate control of bleeding 1
Patient Care
Patients should avoid irritants like smoking and maintain good hydration while awaiting medical care. It is essential to prioritize the patient's respiratory function and overall health when managing haemoptysis. Prompt medical attention is crucial for patients with frank haemoptysis or significant amounts of blood, as it can indicate life-threatening conditions.
From the Research
Definition and Classification of Haemoptysis
- Haemoptysis is defined as the expectoration of blood or bloody streaking of the sputum 2
- It can be classified into minor and major haemoptysis, with major haemoptysis requiring immediate in-hospital diagnostic workup and therapy 2
- The severity of haemoptysis can be assessed by the quantity, frequency, and visual analogue scale (VAS) score of bleeding 3
Causes and Diagnosis of Haemoptysis
- The most common causes of haemoptysis are acute respiratory infections, cancer, bronchiectasis, and chronic obstructive pulmonary disease 4
- A history and physical examination can assist in identifying an etiology, but diagnostic testing is often required 4
- Chest radiography is a good initial test, but it has limited sensitivity for determining the site and etiology of the bleeding 4
- Computed tomography and computed tomography angiography of the chest with intravenous contrast are the preferred modalities to determine the etiology of bleeding 4
- Flexible bronchoscopy plays a pivotal role in the diagnosis of haemoptysis in patients with haemoptoic sputum or frank haemoptysis 5
Management of Haemoptysis
- The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause 6
- Mild haemoptysis often is caused by an infection that can be managed on an outpatient basis with dose monitoring 6
- Tranexamic acid (TA) has been shown to decrease the severity of haemoptysis and can be used as a bridging therapy in acute haemoptysis before definitive intervention can be undertaken 3
- Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent haemoptysis 5
- Surgery is reserved for patients whose medical treatment and embolization are not effective 4