What should I do if I've been coughing up blood since 5:30 AM after working with fine grain dust for 4 hours and have a history of vaping and cigarette use?

Immediate Emergency Department Evaluation Required for Hemoptysis

You need to go to the emergency department immediately—coughing up blood (hemoptysis) after dust exposure with your smoking history requires urgent evaluation to exclude serious causes including lung cancer, acute bleeding disorders, and severe airway injury. 1, 2

Why This Is Urgent

• Hemoptysis always requires investigation in patients over 40 years with smoking history, as lung cancer accounts for 19% of hemoptysis cases and has higher mortality rates 3
• Occupational dust exposure combined with tobacco use creates a 15% risk of occupational chronic bronchitis/COPD, but acute hemoptysis suggests more severe acute injury 4, 5
• Cannabis/vaping use can cause acute hemoptysis through direct airway injury and diffuse alveolar hemorrhage, particularly when combined with other irritant exposures 6

What the Emergency Department Will Do

Initial Stabilization and Assessment

• Assess hemodynamic stability and severity of bleeding—massive hemoptysis (>200-600 mL/24 hours) carries 38% mortality vs 2.5% for mild hemoptysis 3
• Chest X-ray is the mandatory first test, though normal results do not exclude serious pathology including malignancy 2, 3

Definitive Diagnostic Workup

• CT chest with IV contrast (CT angiography) is required in all patients with frank hemoptysis and smoking history—this has 67% diagnostic yield alone and identifies bleeding source 2, 3
• Bronchoscopy combined with CT increases diagnostic yield to 93% and is essential for airway protection in active bleeding, plus excludes lung cancer that CT may miss 2, 3
• Flexible bronchoscopy is first-line if you are hemodynamically unstable with life-threatening bleeding, as it can control hemorrhage at bedside 2

Critical Risk Factors in Your Case

Occupational Exposure Without Respiratory Protection

• Working 4 hours in fine grain dust without proper PPE can cause reactive airways dysfunction syndrome (RADS) or irritant-induced asthma if exposure was high-level 4
• However, hemoptysis is NOT typical of simple irritant bronchitis—this suggests either severe mucosal injury, underlying pathology unmasked by exposure, or coincidental serious disease 5

Tobacco and Vaping History

• 35+ years of on-and-off smoking since age 13 places you at high risk for lung cancer, chronic bronchitis, and COPD 4, 3
• Cannabis/vaping causes visible and microscopic airway injury and has been documented to cause acute hemoptysis with bilateral ground-glass opacities on imaging 6, 7

What to Tell the Emergency Department

Provide this specific information:

• Exact amount of blood: teaspoons, tablespoons, or cups—this determines severity classification 1, 2
• Type of dust exposure: grain, wood, metal, chemical—different dusts have different toxicities 4
• Current vaping substances: nicotine, THC, or other—cannabis specifically linked to hemoptysis 6
• Pack-year smoking history: calculate as (packs per day × years smoked) 3

Common Pitfalls to Avoid

• Do not assume this is "just bronchitis" from dust exposure—hemoptysis requires exclusion of malignancy and other serious causes regardless of recent exposure 1, 3
• Do not delay evaluation hoping it resolves—recurrent hemoptysis without treatment of underlying cause is common, and massive bleeding can develop 1, 2
• Do not attribute everything to occupational exposure—while dust exposure is relevant, your smoking history and age make lung cancer a critical differential that must be excluded 3

Expected Management After Diagnosis

If Simple Irritant Injury

• Exposure avoidance is the dominant intervention—you may need job modification or respiratory protection 5, 8
• Symptomatic treatment with butamirate for cough suppression plus bronchodilators if airflow obstruction documented 5

If Serious Pathology Found

• Bronchial arterial embolization is safest and most effective for massive or recurrent hemoptysis 2
• Surgery reserved only for failed medical/embolization treatment due to extremely high mortality rates 2

Bottom line: Hemoptysis is never normal and always requires investigation. Go to the ED now—do not wait to see if it improves. 1, 2, 3