Evidence summary

Coughing of blood, usually from the lung, is a distressing problem which is most often associated with lung cancer. Other sources of blood may be the oropharynx or gastrointestinal tract. Other common conditions which can be associated with haemoptysis include infection, bronchiectasis, and pulmonary embolus or pulmonary infarct and are of particular concern in haematological malignancy and impaired clotting. [1]
External beam radiotherapy or brachytherapy should be considered to palliate haemoptysis due to lung cancer. [2] There are some studies to support the treatment of bleeding with antifibrinolytic agents, such as tranexamic acid but high level evidence is lacking. [1,3,4]

Practice implications

  • Patients with significant haemoptysis from a lung malignancy should be offered radiotherapy and / or antifibrinolytics as clinically appropriate.
  • Aggressive management of massive haemoptysis (which may involve bronchoscopy and/or intubation, embolisation, or surgery) may not be appropriate when patients have advanced disease. If the patient is at risk of haemoptysis as a terminal event, plans for how this is to be managed to minimise distress to patient, family and caregivers need to be addressed. [4]
  • Acute management plans for haemoptysis should also be developed and might include the availability of dark towels and anxiolytics. [1]

  1. Craig F, Henderson EM, Bluebond-Langner M. Management of respiratory symptoms in paediatric palliative care. Curr Opin Support Palliat Care. 2015 Sep;9(3):217-26. doi: 10.1097/SPC.0000000000000154.
  2. Kvale PA, Simoff M, Prakash UB; American College of Chest Physicians. Lung cancer. Palliative care. Chest. 2003 Jan;123(1 suppl):284S-311S.
  3. Dean A, Tuffin P. Fibrinolytic inhibitors for cancer-associated bleeding problems. J Pain Symptom Manage. 1997 Jan;13(1):20-4.
  4. Pereira J, Phan T. Management of bleeding in patients with advanced cancer. Oncologist. 2004;9(5):561-70.

Last updated 27 August 2021