What to Do If You Experience Coughing Up Blood Due to Bronchiectasis

Bronchiectasis is a chronic respiratory condition characterized by the abnormal widening and thickening of the bronchial tubes in the lungs. This structural damage weakens the airway walls, making them more prone to infections, inflammation, and complications such as hemoptysis—coughing up blood. The damaged blood vessels near the expanded airways can rupture easily, leading to bleeding that ranges from minor streaks in mucus to more severe hemorrhages.

Understanding Hemoptysis in Bronchiectasis

Hemoptysis occurs when fragile blood vessels within or around the dilated bronchi break due to persistent coughing, infection, or increased pressure. While seeing blood in your sputum can be alarming, the severity varies significantly. In many cases, it presents as small streaks of blood mixed with phlegm and may not always indicate a life-threatening issue. However, recurrent or heavy bleeding requires prompt medical evaluation to prevent complications like anemia or respiratory distress.

Mild Hemoptysis: When Minimal Intervention Is Needed

If you only notice occasional blood-tinged sputum and the volume is minimal—less than 5–10 mL per day—it may not require aggressive treatment. Staying calm, avoiding strenuous activity, and monitoring symptoms are essential first steps. Doctors often recommend rest, hydration, and controlling underlying infections with antibiotics if present. Over-the-counter cough suppressants may also help reduce airway irritation and further trauma.

Moderate Bleeding: Managing 100 mL or Less

When daily blood loss reaches up to 100 mL (about half a cup), this is classified as moderate hemoptysis. At this stage, medical intervention becomes necessary. Physicians typically prescribe hemostatic agents to stop the bleeding. Medications such as Yunnan Baiyao capsules—an herbal remedy known for its clot-promoting properties—or intravenous hemostatics like batroxobin (a thrombin-like enzyme derived from snake venom) are commonly used in clinical settings to stabilize patients.

In addition to medication, treating any concurrent lung infection or inflammation is crucial. Sputum cultures and imaging tests like chest X-rays or CT scans help identify triggers and guide therapy. Oxygen support may be provided if oxygen saturation drops, and hospitalization might be advised for close observation.

Severe Hemoptysis: Emergency Treatment Options

Life-threatening hemoptysis is defined as expectorating more than 100 mL of blood within 24 hours, especially if it interferes with breathing. Large volumes of blood can obstruct the airway, increasing the risk of asphyxiation—a medical emergency requiring immediate attention.

Interventional Radiology: Bronchial Artery Embolization (BAE)

For severe or recurrent bleeding, bronchial artery embolization (BAE) has become the gold standard non-surgical treatment. During this minimally invasive procedure, an interventional radiologist threads a catheter through the femoral artery into the bronchial arteries supplying the affected area. Once the bleeding vessel is identified using angiography, tiny particles or coils are injected to block the vessel and stop the hemorrhage.

Studies show that BAE is effective in over 85% of cases, offering rapid control of bleeding with lower risks compared to open surgery. It's particularly beneficial for patients who are not surgical candidates due to poor lung function or comorbidities.

Surgical Intervention: A Last Resort

In rare instances where embolization fails or the disease is localized to one lung segment, surgical resection may be considered. Removing the diseased portion of the lung can provide a definitive cure but carries higher risks and requires thorough preoperative assessment.

Preventing Recurrence and Long-Term Management

Managing bronchiectasis effectively reduces the likelihood of future bleeding episodes. Regular use of airway clearance techniques, inhaled medications, and prompt treatment of infections play key roles. Annual flu vaccines, pneumococcal vaccination, and avoiding smoking are also critical preventive measures.

Patients should maintain regular follow-ups with pulmonologists and report any signs of worsening cough, increased sputum production, or recurrence of blood in sputum immediately. Early detection and tailored care significantly improve quality of life and reduce hospitalizations.