From the Guidelines
Hemoptysis is most commonly caused by bronchiectasis, respiratory infections, and lung carcinomas in large tertiary referral centers in North America and Europe, while tuberculosis and its sequelae remain the most prevalent cause in developing countries, as reported in the study by 1. The causes of hemoptysis can vary based on the level of medical care facility and geographic location of the patient.
- In the outpatient primary care setting, the most common causes of hemoptysis are acute respiratory tract infections, chronic obstructive pulmonary disease, malignancy, and bronchiectasis.
- In large tertiary referral centers in North America and Europe, the most common causes of hemoptysis are bronchiectasis, respiratory infections, and lung carcinomas.
- Tuberculosis and its sequelae remain the most prevalent cause of hemoptysis in developing countries. Other causes of hemoptysis include:
- Sarcoidosis
- Autoimmune disease resulting in capillaritis or cavitation
- Coagulopathies
- Sequelae from respiratory infections
- Vascular causes such as pulmonary arteriovenous malformations, pulmonary pseudoaneurysms, and pulmonary artery aneurysms. According to the study by 1, hemoptysis without a known cause despite extensive investigation by both CT and bronchoscopy is termed “cryptogenic hemoptysis” and accounts for approximately 20% of patients initially presenting with hemoptysis. The severity of hemoptysis ranges from blood-streaked sputum to massive bleeding requiring immediate medical attention, with the latter being a medical emergency that can lead to respiratory compromise and death if not promptly addressed, as discussed in the studies by 1.
From the Research
Common Causes of Hemoptysis
The common causes of hemoptysis include:
- Acute respiratory infections
- Cancer
- Bronchiectasis
- Chronic obstructive pulmonary disease (COPD) 2 It is worth noting that in 20% to 50% of cases, no cause is identified 2.
Diagnosis and Treatment
Diagnosis of hemoptysis involves determining the severity of bleeding and stability of the patient, and may require bronchoscopy for airway protection 2. Treatment of hemoptysis includes supportive medical treatment and treatment of the underlying etiology, as recurrence often takes place in the absence of treatment of the identified cause 2. Tranexamic acid (TXA) has been shown to reduce bleeding volume, further intervention risk, and length of hospital stay in patients with hemoptysis 3, 4. Nebulized TXA has also been found to be an effective and safe non-invasive treatment option for hemoptysis, particularly in non-massive cases 4.
Management of Hemoptysis
Management of hemoptysis may involve: