Coughing up blood: bloody cough

Coughing up blood: bloody cough

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Coughing up blood (hemoptysis, hemoptysis) is generally an extremely serious symptom, which can be related to various serious diseases of the respiratory tract. A medical examination of the complaints is therefore urgently required - in case of doubt, an emergency doctor should be alerted.


Ultimately, any form of cough in which blood is released through the respiratory tract is to be understood as coughing up blood - regardless of the amount of blood involved. Therefore, the symptoms of haemorrhage in the professional world are further divided into the so-called hemoptysis, in which blood inclusions can be observed in the sputum (sputum), and the haemoptysis, in which larger amounts of blood are coughed up directly.


Depending on their causes, the various forms of coughing up the blood can be accompanied by different accompanying symptoms, which are described below in connection with the respective diseases. However, there are also imminent complaints as a result of blood loss from coughing up blood. For example, if this goes unnoticed for a longer period of time, anemia can develop, which is accompanied by further impairments. Heavy blood loss, such as occurs with a hemoptysis, often causes circulatory shock. Heart rate, pale skin, cold sweat, breathing problems and impaired consciousness are possible consequences here. In the worst case, excessive blood loss can lead to patient death within a relatively short period of time.


The spectrum of possible causes of coughing up blood ranges from acute lung injuries and structural impairments of the bronchial tubes to bacterial and viral respiratory infections and lung cancer. The symptoms can differ significantly according to the different causes, both with regard to the form of the blood cough itself and with regard to the ascertainable accompanying symptoms. The following is a more detailed description of the possible causes of hypertension and the accompanying symptoms.

Respiratory infections

The most common causes of coughing up blood are infections of the respiratory tract which cause severe bronchitis or pneumonia. In addition, coughing up blood is also part of the symptoms in the case of special, rather rare diseases of the respiratory tract, such as pulmonary tuberculosis or legionellosis. This also applies to an infection of the lungs with mold spores - the so-called Aspergilloma.

Bronchitis Bronchitis is defined as inflammation of the bronchi (air-conducting airways between the trachea and alveoli) or the bronchial mucosa. This can be caused by various causes (e.g. smoking), but mostly viral infections are the cause of the symptoms. Bronchitis is characterized by a strong, initially dry cough, which is accompanied by general symptoms such as sore throat, hoarseness, body aches, headache, fever and runny nose. With severe forms of the course there is a risk of damage to the mucous membrane structures, which can be accompanied by slight bleeding of the mucous membrane and corresponding hemoptysis. Acute bronchitis sometimes develops a chronic complaint, such as the well-known smoker's cough, whereby the accompanying general complaints are often missing or reduced to shortness of breath and poor performance.

Pneumonia If the air-conducting structures of the lungs are not affected by an inflammation, but rather the lung tissue involved in the gas exchange, experts refer to pneumonia or pneumonia. Bacteria from the genus pneumococci, staphylococci or Haemophilus influenzae can be mentioned here as possible triggers. Flu viruses and adenoviruses can also cause severe pneumonia. The same applies to various other virus strains, fungi and protozoa. The appearance of pneumonia is usually quite similar to bronchitis and begins with a strong cough, difficulty breathing and difficulty breathing. The sputum is purulent and sometimes with blood inclusions in severe courses. High fever, chills and chest pain are also typical symptoms. Non-specific symptoms such as headaches and body aches can also be added. All in all, pneumonia, especially for children, the elderly and immunocompromised patients, can be seen as a very threatening illness, which can be fatal in the worst case.

Tuberculosis Lung tuberculosis is a special form of bacterial respiratory infections, in which inflammation forms in the affected lung tissue, which the organism tries to encapsulate. If this does not succeed, initially there are rather unspecific complaints such as tiredness, poor performance, mild fever and persistent cough. Coughing up blood in the form of hemoptysis can only be observed in particularly severe forms. Tuberculosis is generally not limited to the lungs, but can also affect various other organs. If the pathogens spread in the organism, this often leads to the death of the patient if treatment is neglected. Medical care for those affected is therefore urgently required

Legionnaires 'disease / legionnaires' disease Legionnaires 'disease or so-called legionnaires' disease is a bacterial infection that is associated with severe pneumonia and, in addition to more unspecific complaints such as fever, chills, headache and irritable cough, can also cause coughing up blood. It is not uncommon for Legionnaires' disease to take on life-threatening proportions, and due to the high level of infectiousness, local clustering of the diseases is often observed. In addition, if there is no circulation and disinfection, the bacteria can multiply in various water tanks such as hot water systems, air conditioning systems, cooling towers or whirlpools. The consequence is also a greatly increased local occurrence of the infections. For example, multiple guests at a particular hotel or swimming pool are affected.

Cancer and coughing up blood

Both lung cancer and metastatic cancers of other organs, in which lung metastases are formed, can lead to the destruction of lung tissue and coughing up blood. For example, coughing up blood is a possible indicator of lung cancer or advanced bronchial carcinoma. Symptoms such as fever, coughing, a stinging in the chest and breathing problems are usually observed in advance for a long time. Lung metastases - cancer cells that have migrated into the lungs from other organs, for example via the blood system - often behave inconspicuously in the early stages, but can lead to coughing up blood later. In addition to coughing, shortness of breath and chest pain, an inexplicable weight loss can often be observed here.

Other causes of coughing up blood

Structural, non-infectious changes in the lung tissue as well as acute injuries to the lungs or chest, but also diseases of the cardiovascular system and special autoimmune diseases (e.g. goodpasture syndrome) are possible further causes of coughing up blood.

Bronchiectasis Pathological, irreversible damage to the bronchi in the form of so-called bronchiectasis, such as may occur as a result of early childhood illnesses or with cystic fibrosis, is occasionally associated with coughing up blood in particularly severe cases and / or subsequent infections. In general, however, those affected tend to suffer from a severe cough, in which relatively large amounts of secretions are coughed up. A noticeable symptom of bronchiectasis is clearly visible swelling of the fingers and toes (drumstick fingers).

Cardiovascular diseases One possible cardiovascular cause of coughing up blood is, for example, narrowing of the heart valves (mitral valve stenosis). Blood congestion in the lungs often causes not only shortness of breath, but also coughing up blood, especially in severe cases. Since mitral valve stenosis is associated with a significantly increased risk of fatal embolism, heart disease and pulmonary edema, heart valve defects urgently need medical attention. If the blood vessels in the lungs are blocked by a thrombus, this can also lead to coughing up blood. This so-called pulmonary embolism is associated with breathing problems and increased cardiac stress, which in turn can lead to heart failure in the worst case. In general, cardiovascular diseases, which are accompanied by a significant increase in blood pressure in the lungs (pulmonary hypertension), are also to be considered as possible causes of coughing up blood. If blood clotting is significantly reduced due to the use of certain medications or as a result of the blood disease, this can also lead to increased bleeding from tiny injuries within the lungs and thus also cause coughing up blood.

Goodpasture syndrome This very rare autoimmune disease primarily targets the blood vessels in the renal corpuscles and lungs, although not all patients have lung involvement. If there is a Goodpasture syndrome with lung involvement, coughing up blood is one of the conspicuous accompanying symptoms. Above all, however, there are impairments of kidney function that can be associated with symptoms such as blood in the urine or protein precipitations in the urine (proteinuria). Without treatment, the Goodpasture syndrome is usually fatal, but the majority of patients can be saved with drug treatment and special blood purification.

Acute chest injuries If the lungs are injured by acute force on the chest, for example in a traffic or sports accident, and blood enters the lungs, coughing up blood is a typical consequence. Since the lungs were usually damaged from the outside in such cases, those affected often have significant breathing problems and without medical care, the patient can die within a relatively short time.

Diagnosis and treatment of coughing up blood

The treatment of coughing up blood requires treatment of the actual causes of this symptom, although there is only a small chance of cure for individual diseases such as lung cancer. If larger amounts of blood are coughed up, the first step is often to first close the blood vessels to stop the bleeding. This is done, for example, by means of bronchial artery embolization, although the risk of recurrence of the bleeding is relatively high and the actual cause of the bleeding remains untreated.

If the acute bleeding has stopped, the search for its causes follows. In the case of injuries caused by external force, this is usually relatively easy to complete and pneumonia or bronchitis can usually be determined with little effort. If lung cancer is suspected, imaging methods such as X-rays and computed tomography (CT) are of particular importance, but bronchoscopy (mirroring the bronchi) with a tissue sample may also be necessary to confirm the diagnosis. Imaging and bronchoscopy are also the most important diagnostic tools for determining bronchiectasis. In addition, heart valve defects can also be identified quite reliably using special x-rays, CT and MRI (magnetic resonance imaging), whereby echocardiography and the electrocardiogram can also provide important diagnostic information. Echocardiography in particular also serves to demonstrate pulmonary hypertension.

Blood tests, for example, play an important role in the detection of goodpasture syndrome or tuberculosis, and for the latter a laboratory test of the cough secretion (sputum or sputum) can also be carried out to ensure the diagnosis. Examination of the blood and sputum may also provide evidence of other respiratory bacterial infections.

Once the cause of the blood cough has been determined, targeted therapy can begin, with the spectrum ranging from expectorant and antitussive drugs to antibiotic use in bacterial infectious diseases to surgical interventions to remove damaged lung tissue and accompanying chemotherapy and / or radiation therapy for lung cancer . Surgery may also be necessary in the event of a heart valve defect. This also applies to pulmonary embolism if drug treatment with blood-thinning or anticoagulant drugs does not show the desired success. Ultimately, the selection of the appropriate treatment not only depends on the underlying disease, but in many cases is also largely determined by the stage of the disease at the time of diagnosis. The individual constitution of the patient also plays an important role here.

Naturopathy for coughing up blood

Naturopathic treatment methods can only help to a limited extent for coughing up blood and especially in acute forms with coughing up of large amounts of blood, a purely naturopathic therapy is not an option, since the underlying bleeding cannot be stopped with it. If, on the other hand, the coughing up of blood is caused, for example, by chronic bronchitis, there are certainly naturopathic treatment options that can be used concomitantly. Here, for example, measures that generally strengthen the immune system or various home remedies for coughs provide relief. Homeopathy also knows a few remedies that can be helpful for respiratory infections or pneumonia. However, these are also only of a supportive nature, and healing based solely on them is generally not possible. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


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ICD codes for this disease: R04ICD codes are internationally valid encryption for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

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