Dr. K. K. Pandey
In the Indian subcontinent, individuals of all ages suffer from cough at various stages of life. With the onset of winter, cough frequency often increases, and a dry cough may turn wet with white secretions. Recurrent or non-stop episodes of dry cough should be a cause for concern—let alone coughing up blood. Hemoptysis (coughing up blood) is a serious and potentially dangerous symptom. Negligence in such a situation amounts to an open invitation to death. Always remember: treat bloody phlegm with utmost seriousness and consult a thoracic surgeon promptly. A precious life may otherwise be lost to ignorance.
Why does blood appear during coughing?
There are multiple causes of hemoptysis. In our country, the most significant cause is tubercular infection. When tuberculosis is not properly treated and reaches a fulminant stage, the patient may begin coughing up blood. Bleeding can sometimes be so severe that the infected person dies within hours due to exsanguination or flooding of the opposite healthy lung with blood.
Frequently, even after successful TB treatment, a patient may continue to cough up blood. This condition is medically termed aspergilloma or aspergillosis, which can be responsible for recurrent bleeding.
Avoid recurrent lung infections
The second important cause of bloody phlegm is bronchiectasis. In this condition, the walls of the bronchi (windpipes) are severely damaged by persistent swelling and inflammation due to repeated infections. Adjacent blood vessels become thin and dilated. Due to these changes, the vessels may rupture under increased pressure from coughing, leading to bloody sputum. A patient with bronchiectasis should consult a thoracic or chest surgeon and consider surgical removal of the damaged lung portion as early as possible; otherwise, the remaining healthy lung may also become diseased.
Avoid smoking—it invites lung cancer, a cause of bloody sputum
The third major cause of hemoptysis in our country is lung cancer. In both small and large cities, the increasing trend of smoking among youth has steadily raised the number of lung cancer cases. Smoking not only causes lung cancer but also leads to the narrowing of blood vessels that supply oxygenated blood to vital organs, potentially resulting in loss of lung function and even limbs. If a chronic smoker coughs up blood, lung cancer must be ruled out.
Lung abscess can also cause bloody phlegm
The fourth significant cause is lung abscess—a collection of pus inside the lung. Severe infection weakens blood vessels, which may rupture due to a sudden rise in pressure during coughing, resulting in blood-streaked sputum.
Other factors for bloody sputum
Some individuals may have congenital deformities in the lung’s blood vessels, such as pulmonary arteriovenous malformation (PAVM). In this condition, abnormal connections exist between arteries and veins from birth, which can lead to bleeding.
Chest injury may also result in bloody sputum
After accidents or old chest injuries, pus may collect in the chest cavity, leading to a bronchopleural fistula—an abnormal connection between the bronchus and the pleural space. In such cases, coughing may produce bloody phlegm.
Where to go if you are coughing up bloody sputum?
If you suffer from chronic cough with bloody phlegm, do not delay. Consult a thoracic surgeon—not a general surgeon. Seek a hospital with a full-time thoracic surgeon where lung and heart surgeries are routinely performed. To determine the cause and extent of the condition, advanced investigations such as bronchoscopy, thoracoscopy, CT-guided biopsy, and parasternal mediastinotomy may be required. Angiography facilities are also crucial in emergencies to control life-threatening bleeding.
What to do when you cough up bloody sputum?
Consult a thoracic surgeon at the earliest. If a part of the lung is irreversibly damaged by infection, surgical removal may be necessary to permanently control bleeding and protect the remaining healthy lung tissue.
If lung cancer is the cause, removal of the affected lung (pneumonectomy) may be the only way to save the patient’s life and prevent the cancer from spreading to the other lung.
Can you live normally with one lung?
Many people worry whether a person can survive with one lung. This is a misconception. Just as a person can live normally after donating a kidney, one can lead a healthy life after the removal of one lung. Do not hesitate to opt for surgery if medically advised—it may be the only way to save a life. Lung surgery should always be performed by an experienced thoracic surgeon.
Dr. K. K. Pandey
Senior Thoracic & Cardiovascular Surgeon
Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi
dr********@***il.com