Why Am I Coughing Up Blood?

Call 911 if you cough up more than a teaspoon of blood

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Coughing up blood, otherwise known as hemoptysis, can be frightening. But, it can also be confusing because you may not know where the blood is coming from. Is it coming from the nasal passages, the esophagus (feeding tube), the trachea (windpipe), the lungs, or your stomach?

While hemoptysis is a tell-tale sign of lung cancer, it is more often due to a benign (non-cancerous) cause. These include causes like bronchitis, pneumonia, and the use of blood thinners.

This article looks at the possible causes of hemoptysis as well as how the condition is diagnosed and treated. It also describes when coughing up blood can be a medical emergency.

Coughing up blood causes

Verywell / Nusha Ashjaee

What Causes You to Cough Up Blood?

There are many different reasons why you may be coughing up blood. Some are more serious than others, but there is generally no way to tell by just looking at it. Coughing up blood in any amount should be taken seriously.

Some possible causes of hemoptysis include:

Hemoptysis and Lung Cancer

Hemoptysis is the only symptom in only 7% of people diagnosed with lung cancer and is considered the symptom most specific for the diagnosis.

Causes in Children

Coughing up blood in children tends to have different causes than in adults. The most common causes are respiratory infections, such as pneumonia, bronchitis, and tuberculosis. Underlying heart disease is the second most common cause in children.

Roughly one-third of hemoptysis cases in children are idiopathic (meaning of unknown origin) with symptoms resolving without ever determining the cause.

When to Go to the Hospital

Coughing up blood can quickly become an emergency. Coughing up more than one teaspoon of blood is considered a medical emergency.

Coughing up 100 cubic centimeters (cc) of blood—1/3 of a cup—is called massive hemoptysis and has a mortality (death) rate of 30% to 50%.

If coughing up large amounts of blood, do not drive yourself to the hospital or have someone else drive you—call 911. Coughing up blood in these volumes can cause airway obstruction and infiltration of the blood into your lungs, leading to suffocation and death.

When to Call 911

Call 911 if you experience chest pain, shortness of breath, or lightheadedness, even if you cough up just a trace of blood.

Testing for Causes of Hemoptysis

If you cough up blood—even a very small amount—it is important to see your healthcare provider. If possible, bring a sample of what you have been coughing up to your appointment. Wrapping the sample in plastic wrap can preserve it better than wrapping it in tissue.

The diagnosis will involve a review of your medical history and a physical exam. The healthcare provider will not only examine your mouth and throat but listen for lung sounds using a stethoscope.

Based on the findings, your healthcare provider will recommend tests to help determine the cause. This may include:

If you are actively bleeding, a CT scan is usually the imaging test of choice.

A timely diagnosis is essential when you have hemoptysis. While the cause may ultimately be benign or treatable, an early diagnosis almost invariably leads to better outcomes irrespective of the cause.

Such is the case with lung cancer in which the average time between the onset of symptoms and diagnosis is 12 months. This is a span of time during which treatment can make a big difference in the outcome of the disease.

Hemoptysis or Something Else?

During the evaluation, your healthcare provider will determine whether the blood you are coughing up is from the respiratory tract or some other part of the body.

For example:

  • Pseudohemoptysis is the coughing up of blood not from the lungs.
  • Hematemesis is the vomiting of blood from the digestive tract.

Each is treated differently and can be difficult to tell apart. In many cases, only an evaluation from a healthcare provider can pinpoint the source of the bleeding.

How Is Hemoptysis Treated?

While it is important to find the underlying cause of hemoptysis, the symptom sometimes needs to be treated directly (and immediately) even if the cause is not entirely clear.

The first step in managing hemoptysis is to make sure the airway is protected. Intubation (the insertion of a breathing tube) may be necessary, especially with massive bleeding.

When the bleeding is mild, treatment may be focused on managing the underlying cause. Otherwise, the following options may be considered.


There are several techniques that can be used during a bronchoscopy to manage the bleeding. These are most effective when the bleeding is mild or moderate.

Options include:

  • Endobronchial insertions: These are substances that are delivered through the bronchoscope to stop bleeding, such as iced saline, cellulose, and an organic fiber known as fibrinogen.
  • Argon photocoagulation: This is a technique used to form blood clots locally.
  • Electrocautery: This involves electricity to burn tissues to stop a bleed.
  • Endobronchial stent placement: This involves the insertion of a tube into blood vessels to redirect circulation after the bleeding has been stopped.

Bronchial Artery Embolization

When the bleeding is massive, bronchial artery embolization is typically the first-line treatment. In this procedure, a tube called a catheter is inserted into an artery in the upper thigh and threaded to the lung to the site of the bleeding.

Once in place, various substances are injected through the catheter to embolize (create a clot) in the artery. Options include a gelatin sponge, PVC particles, or a metallic coil.


Surgery is needed less often in the past for hemoptysis but may still be used in situations where there is massive hemoptysis due to trauma.

This may include a type of surgery called a wedge resection in which a wedge of lung tissue is removed and the cut ends are sewn together. This may be performed with traditional open surgery or minimally invasive video-assisted thoracoscopic surgery.


Coughing up blood (hemoptysis) can be caused by many different things, from violent coughing and chronic lung disease to respiratory infection and lung cancer. There is no way to tell what is involved without an evaluation by a healthcare provider.

Coughing up any amount of blood warrants a medical business, but coughing up more than a teaspoon is considered a medical emergency. Massive hemoptysis (coughing up a 1/3 cup of blood or more) correlates with a high risk of death.

While the underlying cause of hemoptysis needs to be addressed, other interventions may be needed to stop the bleeding. This includes substances that cause clotting at the site of the bleeding or tools that use heat (cautery) to seal ruptured vessels. Surgery may be needed in cases of trauma.

Frequently Asked Questions

  • Is coughing up blood a sign of COVID?

    Not typically. In rare instances, people do cough up blood. According to some reports, fewer than 1% to 5% of people admitted to the hospital for COVID suffer from this symptom. It has also been seen in people recovering from COVID-related pneumonia.

  • Why am I coughing up blood with bronchitis?

    The blood may be from your nasal passages, throat, lungs, or airways, where blood vessels may tear by the force of coughing or irritation. If the amount of blood is very small, it shouldn’t be a problem, but let your doctor know so you can be sure it’s not a more severe lung infection.

  • Can medications cause you to cough up blood?

    Yes. Blood thinners, also known as anticoagulants, can sometimes cause you to cough up blood. These medications include Coumadin (warfarin), Xarelto (rivaroxaban), and Pradaxa (dabigatran). Call your doctor immediately if you experience this.

  • Can acid reflux cause you to cough up blood?

    Hemoptysis (coughing up blood) is a rare occurrence with gastroesophageal reflux disease (GERD) and acid reflux but has been known to occur if there is an underlying or undiagnosed condition like bronchiectasis.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."