Noticing Blood When You Cough? Causes and When to Seek Care

Noticing An Unusual Metallic Taste When Coughing? Here's What You Need to Know

Coughing up blood can be an alarming experience. You may suddenly notice a strange, metallic taste in your mouth after a bout of coughing. Seeing blood when you cough is understandably concerning, but try not to panic. There are many potential causes, and the severity can range from mild to serious.

In medical terms, coughing up blood is called hemoptysis. It occurs when bleeding happens in the lower respiratory tract such as the trachea (windpipe) or bronchi (airways leading to the lungs). The blood then mixes with mucus and is coughed up.

Hemoptysis is a symptom of an underlying medical condition. Identifying the cause is crucial for proper treatment. Here's an overview of the common causes, how to tell if your symptoms may be serious, and when to seek immediate medical care.

What Causes Blood When Coughing?

There are many possible medical reasons for coughing up blood. Some of the most common include:

• Bronchitis
• Pneumonia
• Lung cancer
• Pulmonary edema
• Pulmonary embolism
• Tuberculosis
• Fungal infections
• Abscess in the lung
• Damage to blood vessels

Let's go over these causes in more detail:

Acute Bronchitis

Acute bronchitis is inflammation of the large airways (bronchi) leading to the lungs, usually due to a respiratory infection. It often causes coughing that may produce phlegm or mucus. In some cases, the coughing can irritate the bronchial tubes and cause minor bleeding.

With acute bronchitis, coughing up blood is usually minimal. You may notice a few streaks or specks of blood mixed with mucus. It should go away once the infection clears in a week or two.

Pneumonia

Pneumonia is a lung infection that causes inflammation in the alveoli (tiny air sacs in the lungs). There are several types of infectious pneumonia as well as aspiration pneumonia, which happens when you inhale food, liquid, gases or dust into the lungs.

Pneumonia can cause extensive inflammation and damage in the lungs. Coughing up frothy blood or blood-streaked sputum may occur as the infection irritates and causes bleeding in the airways. Pneumonia requires treatment with antibiotics and proper care.

Lung Cancer

Lung cancer is one of the most serious causes of hemoptysis. Cancerous lung tumors can grow and block off sections of the bronchial tubes. This makes you prone to infections, which can cause bleeding.

In advanced cases, the tumor may erode into a blood vessel, causing heavy bleeding into the lungs. Coughing up blood is often one of the first signs of lung cancer. Any suspected cancer warrants urgent medical evaluation.

Pulmonary Edema

Pulmonary edema refers to fluid buildup in the lungs, usually due to heart problems. When the heart is unable to pump efficiently, blood can back up into the pulmonary veins and seep into the air spaces.

This fluid congestion can cause irritation and inflammation in the lungs. You may cough up frothy, blood-stained sputum. Pulmonary edema is a serious condition that requires emergency treatment.

Pulmonary Embolism

A pulmonary embolism happens when a blood clot travels to the lungs and blocks an artery. This can damage the lung tissues and vessels, causing irritation and bleeding.

Coughing up blood is a common symptom of a pulmonary embolism. The severity depends on the size of the clot. Small clots may cause mild bleeding that is usually self-resolving. Large clots can lead to heavy bleeding and are extremely dangerous.

Tuberculosis

Tuberculosis (TB) is a bacterial lung infection. In active TB disease, the bacteria damage lung tissue, causing inflammation and bleeding. Coughing up small amounts of blood is common.

TB is highly contagious. Any hemoptysis due to suspected TB requires immediate isolation and medication to prevent spreading it to others.

Fungal Infections

Fungal infections such as aspergillosis, histoplasmosis and coccidioidomycosis can cause hemoptysis. Fungi can infect damaged lung tissue and destroy blood vessels, leading to bleeding.

Fungal pneumonia is most common in people with lung disease or weakened immune systems. Coughing up blood warrants medication to clear the infection before it spreads in the body.

Lung Abscess

A lung abscess is a pus-filled cavity in the lungs, usually due to a bacterial infection. Large abscesses can erode blood vessels and rupture, causing bleeding into the airways.

Coughing up pus or blood-streaked sputum may be signs of an abscess. It requires potent antibiotics to clear the infection, and sometimes drainage or surgery.

Damage to Blood Vessels

Anything that damages the airways and vessels in the lungs can make you prone to bleeding. Possible causes include:

• Chronic inflammatory lung diseases such as chronic bronchitis or interstitial lung disease
• Injury due to violent coughing fits
• Chest trauma
• Lung surgery like a biopsy
• Mechanical ventilation that injures the airways
• Swallowing caustic substances like cleaning liquids

The resulting damage to the delicate lung tissues makes them more likely to bleed when aggravated. The treatment focuses on addressing the underlying lung condition or source of injury.

How to Tell if Hemoptysis is Serious

Mild hemoptysis may not be an emergency, especially if caused by acute bronchitis. But severe or persistent bleeding requires prompt medical attention. Here are some signs of potentially serious bleeding:

• Coughing up more than about half a cup of blood
• Vomiting blood or bloody mucus
• Blood that is bright red or frothy, rather than dark or streaked
• Feeling short of breath or chest pain after coughing up blood
• Dizziness, sweating or rapid heart rate
• Fever, chills, or other signs of infection
• Weakness or excessive fatigue after coughing episodes
• Blood with a foul odor like feces

These may be signs of profuse bleeding or an underlying condition like cancer, blood clots, heart problems or lung abscess. Make an urgent call to your doctor if you experience any severe symptoms along with coughing up blood.

When to Seek Emergency Care

While mild hemoptysis can sometimes clear up on its own, it's always best to see a doctor for evaluation. Call 911 or emergency services immediately if you have:

• Coughing up copious amounts of blood
• Bleeding that does not stop or keeps recurring
• Severe shortness of breath or chest pain after coughing blood
• Fainting, severe dizziness or collapsing
• Gasping for air or inability to catch your breath
• Coughing up blood and have been diagnosed with a serious lung disease

These may be signs of a life-threatening emergency such as a severely injured blood vessel or heavy internal bleeding. Prompt medical care is crucial.

When to See Your Doctor

Aside from emergencies, you should call your doctor promptly for evaluation if you:

• Notice blood when coughing for the first time
• Have an existing lung condition and cough up blood
• Cough up blood after recovering from a lung infection
• Have blood in your sputum for more than a few days
• Are coughing up blood-streaked phlegm or small clots
• Have any signs of infection along with coughing blood

Even if the bleeding stops, don't ignore recurrent hemoptysis. See your doctor to determine the cause and necessary treatment. This is especially important if you have risk factors like smoking, recent lung infection, or chronic lung disease.

What to Expect at the Doctor's Office

Be prepared to describe your symptoms and any history of lung problems. Your doctor will likely ask:

• When did you first notice blood in the sputum or phlegm?
• How often does it happen when coughing?
• How much blood do you cough up each time?
• Is it bright red, or dark and streaked?
• Do you have any other symptoms like fever, chest pain, or trouble breathing?
• Do you smoke or have any lung illness?

Your doctor will listen to your breathing through a stethoscope. They may order imaging tests like:

• Chest X-ray
• CT scan of the lungs
• Ultrasound of the heart (echocardiogram)

You may also need to provide sputum samples for culture, especially if pneumonia or tuberculosis are suspected. Blood tests, EKG, and bronchoscopy (viewing the lungs through a tube inserted through your mouth) may be done in some cases.

Treatment will depend on the cause found for the bleeding. Getting prompt care is vital, especially with severe hemoptysis, to prevent potentially life-threatening complications.

How is Hemoptysis Treated?

Treatment focuses on stopping any active bleeding and dealing with the underlying cause. Your doctor may recommend:

• Blood vessel constricting medications to reduce bleeding
• Blood pressure support through IV fluids if bleeding is severe
• Oxygen therapy to help with breathing and prevent hypoxia
• Medications like bronchodilators to open the airways
• Treating any infections with antibiotics or antifungals
• Blood thinners if a pulmonary embolism caused the bleeding
• Surgery to stop bleeding vessels, drain lung abscesses, or treat impacted tumors if cancer caused the hemoptysis

During bleeding episodes, you'll be advised to rest, avoid strenuous activity, and prevent coughing or clearing your throat as it can worsen bleeding.

If the hemoptysis was due to an infection like bronchitis, the bleeding itself often resolves once the illness clears. But it's still crucial to get the underlying cause evaluated, especially for recurrent or severe cases.

When Can Hemoptysis Be Managed at Home?

Mild hemoptysis caused by acute bronchitis or irritation may not require extensive treatment. Your doctor may advise home care if:

• The bleeding is minimal, with only specks or streaks of blood when coughing
• It occurs occasionally and settles within a day or two
• You have no other severe symptoms like chest pain or difficulty breathing
• You are otherwise healthy without chronic lung illness or risk factors like smoking

You can manage mild hemoptysis at home by:

• Resting to avoid aggravating the bleeding
• Avoiding cough and throat-clearing
• Using a humidifier to moisten and soothe the airways
• Consuming warm fluids to loosen mucus gently
• Using honey to coat and soothe the throat
• Taking over-the-counter cough medicine if your doctor approves

Drink adequate hydration and get medical care quickly if bleeding increases or you develop any severe symptoms. Even if it resolves, follow up with your doctor to determine if any underlying lung conditions need treatment.

How Can Hemoptysis Be Prevented?

While anyone can experience hemoptysis, you may be able to reduce your risk by:

• Treating any respiratory infections promptly
• Getting vaccinated against pneumonia and flu
• Avoiding smoking and secondhand smoke
• Using protective masks if working in environments with dust, chemicals or irritants
• Getting regular medical care for chronic lung illness like COPD
• Taking blood thinners if at risk for clots

See your doctor about any persistent cough, fatigue, difficulty breathing or other symptoms of lung disease. Proper treatment of underlying conditions can lower chances of problems like hemoptysis.

When to Worry About Coughing Up Blood

Hemoptysis is always abnormal and warrants medical evaluation. While mild bleeding may resolve, significant or recurrent episodes can signal potentially serious problems. Seek emergency care for heavy bleeding, difficulty breathing, fainting or any signs the bleeding is not stopping. Call your doctor promptly even for minor bloody sputum to determine if lung disease or cancer could be brewing.

With prompt care, hemoptysis is often treatable and controlled. But never ignore coughing up blood, as identifying the cause is vital for proper treatment and preventing complications. By recognizing warning signs and seeking timely medical care, you can get the best outcome and relief if you notice an unusual taste of blood when coughing.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.