Coughing up a lot of blood: what to do

Blood coughed up from the lower airways is called haemoptysis. A large amount may reflect bleeding from an inflamed or damaged airway, a severe infection such as pneumonia, or a blood vessel problem such as pulmonary embolism. Bronchiectasis can make airways prone to repeated bleeding. Tuberculosis and lung cancer are other conditions clinicians may need to consider; the symptom alone cannot identify its cause.

The appearance can vary from streaks mixed with mucus to fresh blood or clots. Blood from the mouth, nose or stomach can look similar, so tell the emergency team exactly what happened and whether you were coughing, vomiting or bleeding elsewhere.

Call emergency services and describe the amount, colour and timing of the blood. Sit upright or lean slightly forward so blood is less likely to enter the lungs. Spit blood into a container if practical, rather than swallowing it. Do not eat or drink unless emergency clinicians advise it, and do not take a new cough suppressant or blood-thinning medicine without instruction. Bring a list of medicines and tell responders about lung disease, recent procedures and any blood thinners.

Emergency help is needed for more than a small streak, ongoing bleeding, clots, breathlessness, chest pain, faintness, fast heartbeat, confusion or pale, clammy skin. Treat any recurrence seriously, even if the bleeding stops. A clinician may check breathing and circulation and arrange imaging or blood tests to locate the source.

Ask what source of bleeding is suspected, which tests are needed, whether any medicines should be paused, and what warning signs require returning immediately. Share smoking history, previous lung infections, recent travel, surgery and all prescribed or non-prescribed medicines.