Asthma and coughing up blood

Blood may appear as streaks mixed with mucus or as a larger amount. It can come from irritated airways, infection or another chest problem, while blood from the nose, mouth or stomach can sometimes be mistaken for blood coughed from the lungs.

Asthma commonly presents with wheezing, chest tightness, cough and variable breathlessness. Visible blood is outside that usual pattern, so it should not be attributed to a forceful cough without clinical assessment.

A clinician may ask about the blood’s colour and amount, whether it was mixed with phlegm, and whether fever, chest pain, breathlessness, leg swelling, weight loss or a recent nosebleed occurred. Medicines, including those that affect clotting, are also relevant.

Sit upright and note what happened, including the appearance of the blood and accompanying symptoms. If safe, a photograph of the sputum can help the clinician. Do not delay care to collect a sample, and do not drive yourself if you feel faint or significantly short of breath.

Use prescribed asthma medicine according to your action plan for simultaneous wheeze or tightness, but do not rely on an inhaler to assess or treat the bleeding. Avoid taking extra medicine unless a healthcare professional directs it, and take your medication list to the assessment.

Call emergency services if there is more than a small streak of blood, bleeding continues or returns, breathing is difficult, chest pain is present, you feel faint, your heart is racing, or your lips or face look blue or grey. Severe asthma symptoms or a reliever that is not helping also require emergency care.

If it was only a small streak and you otherwise feel stable, seek prompt medical advice rather than waiting for it to happen again. The urgency comes from the bleeding and associated warning signs, not from assumptions about how commonly a cause occurs.

Ask where the blood is likely to have come from, which examination or tests are appropriate, and whether any medicine needs adjustment. Explain your asthma pattern separately, including recent attacks, night waking, infections, reliever response and changes in exercise tolerance.