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Why am I coughing up blood? Related conditions and treatments

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated May. 8, 2024  •  Published Oct. 27, 2023
Fact Checked
Causes of coughing up blood
In this article:

Overview: What does coughing up blood (hemoptysis) look like?

Coughing up blood, or hemoptysis, is when a person spits or coughs up blood in their phlegm. Coughing up blood may look like red or pink mucus or red or pink spit. Small streaks or specks of blood in your phlegm that resolve within a day are not usually an immediate cause for concern.

The American Academy of Family Physicians estimates that a primary care provider might encounter the symptom four or five times yearly. Massive hemoptysis occurs in only 15% of cases.

Usually, the cause of hemoptysis is not life-threatening. Still, if you’re coughing up large amounts of blood or if the problem lasts more than a week, you may have a serious infection or a pulmonary embolus and should seek immediate medical attention. Blood visible in mucus or saliva often originates from the lower respiratory tract, although it can come from the nose or throat.

You should get emergency medical attention if a fever, chest pain, dizziness, weight loss, shortness of breath, night sweats, or blood in your stool or urine accompanies your cough, according to the Cleveland Clinic.

Hemoptysis is blood expelled from some part of the respiratory tract. It’s not the same as vomiting blood, which originates in the gastrointestinal (GI) tract, nor the same as bleeding from the mouth.

Key takeaways:

  • Mild hemoptysis is a common symptom most often caused by an infection, like bronchitis, pneumonia, or tuberculosis. Sometimes, coughing up blood results from chest trauma, cystic fibrosis, or, in serious cases, lung cancer or blood clots.

  • Typically, coughing up small amounts of blood does not constitute an emergency, but if you’re coughing up a lot of blood or if the problem persists longer than a week, you should seek immediate medical attention. If you’re also experiencing other symptoms, like shortness of breath, dizziness, chest pain, or back pain, or if your heart is racing, go to your nearest emergency room. If you are concerned, seek emergent medical attention.

  • Coughing up small amounts of blood can usually be managed with close monitoring by your doctor. It typically resolves with treatment within a week.

  • Treatment for coughing up blood varies by cause.

What causes coughing up blood?

There is no single cause for hemoptysis, and some are more serious than others. According to the American Academy of Family Physicians, in as much as 34% of cases, no cause is found.

Some causes of coughing up blood, like blood clots or cancers, can become life-threatening if left untreated.

Common causes of coughing up blood include:

  • Pneumonia or a chest infection

  • Bronchitis or bronchiectasis

  • Tuberculosis

  • Cystic fibrosis

  • Lung cancer

Rare causes of coughing up blood include:

  • Leukemia

  • Throat cancer

  • Pulmonary embolism (blood clot in the lungs)

  • Pulmonary edema

  • COPD (chronic obstructive pulmonary disease)

  • Lung abscess

  • Drug use (like cocaine or crack)

  • Taking anticoagulants (blood thinners)

  • Blunt trauma to the chest

  • A nosebleed that drains into your throat

  • Goodpasture’s syndrome

  • Congestive heart failure

  • Something obstructing the airway

There are some risk factors for coughing up blood causes:

  • A history of smoking

  • Intravenous drug use

  • Use of crack or cocaine

  • Advanced age

  • Pre-existing conditions, like COPD or Goodpasture’s syndrome

  • Use of some medications, like blood thinners

  • Exposure to chemicals like asbestos

Should I be worried about coughing up blood?

Though the most common causes of coughing up blood are not life-threatening when appropriately treated, some are very dangerous to your health. Depending on your lifestyle or pre-existing conditions, the reason you’re coughing up blood may be a sign of a serious problem that requires immediate attention.

If you’re coughing up more than specks or small streaks of blood, or if the problem persists for more than a week, it’s best to see your healthcare provider as soon as possible. 

Go to your nearest emergency room if you’re also experiencing:

For rare people, coughing up blood occurs regularly. For instance, it can be common in people with cystic fibrosis. For people with a history of smoking or drug use, it can indicate respiratory illness like COPD. It’s best to consult your healthcare provider if this happens.

How is the cause of hemoptysis diagnosed?

To diagnose the cause of hemoptysis, a healthcare provider will conduct a physical exam and ask you many questions, like when the problem started, how often you cough up blood, when you cough up blood, and what other symptoms you’re experiencing, like fever, difficulty breathing, sore throat, a persistent cough, or weight loss.

They may ask you to estimate how much blood you’ve coughed up and to describe the color: Is it bright red? The color of rust? Pink? Do you also cough up the white foam with the blood?

Your healthcare provider will also likely ask about your lifestyle and other conditions. For instance, whether you use tobacco or drugs like cocaine and whether you have been exposed to asbestos.

Here are some questions you might hear during the exam: 

  • How much blood do you cough up at once?

  • What color is the blood? (Bright red, dark red, rust-colored, pink, black, etc.)

  • How often does this happen?

  • Is the blood mixed with mucus? Or is it mixed with white foam?

  • Have you ever smoked or vaped? 

  • Do you use drugs like cocaine or crack?

The cause of hemoptysis is diagnosed by a history, physical exam, chest X-ray or CT scan, blood tests, urinalysis, a kidney function test, a bronchoscopy, or a blood-clotting test. The healthcare provider may also ask for a sample of your saliva (called a sputum culture) or the material you’re coughing up.

Is hemoptysis contagious?

Hemoptysis itself is not contagious, but the medical condition causing it may be. For instance, bronchitis, pneumonia (a lung infection), and tuberculosis, which can cause someone to cough up blood, can be spread from person to person. 

To know what causes hemoptysis and whether it is contagious, visit a healthcare provider. 

If you think it might be contagious, quarantine from contact with others and avoid going in public places until hemoptysis symptoms resolve or are otherwise directed by your healthcare provider. 

How long does hemoptysis last?

How long hemoptysis lasts depends on the cause of the problem. Some causes— pneumonia or bronchitis, for example— resolve with antibiotics like Cipro or Albuterol within a week or two.

See your healthcare provider if you’ve been coughing up red mucus for more than a week. 

How to stop coughing up blood

The cause of hemoptysis is often treated with antibiotics, steroids, or cancer treatments. Which coughing-up blood treatments are used depends on the cause of the problem. In mild cases, your healthcare provider may not prescribe a treatment but will wait to see if the symptoms resolve.

Stopping hemoptysis requires treating underlying problems like bronchitis, pneumonia, tuberculosis, cystic fibrosis, or COPD. 

Your healthcare provider may prescribe Ventolin (albuterol), Xopenex (levalbuterol), or Deltasone (prednisone) for bronchitis.

If you have pneumonia, you may be prescribed Cipro (ciprofloxacin), Levaquin (levofloxacin), Oracea (doxycycline), or Relenza (zanamivir).

Tuberculosis treatments include Isoniazid, Rifadin (rifampin), Myambutol (ethambutol), Pyrazinamide, Priftin (rifapentine), BCG Vaccine (Bacille Calmette-Guerin), and Pyridoxine.

To learn how to treat coughing up blood, see a healthcare provider.

Most importantly, coughing up blood can be caused by many things, and it’s best to see your doctor for a diagnosis

Though many causes of coughing up blood are not serious, some can be life-threatening, so it’s best to see a healthcare provider. 

Coughing up blood causes may include bronchitis, pneumonia, other lung infections, or tuberculosis. More serious causes include blood clots and lung cancer. Some causes of coughing up blood may resolve on their own without treatment. 

If you’re coughing up more than just specks or a few streaks of blood, or if you’re experiencing other symptoms like shortness of breath, dizziness, racing heartbeat, chest or back pains, coughing up pure blood, or also seeing blood in your urine or stool, seek immediate medical attention.

Only your healthcare provider can rule out infection or other serious health conditions. Visit your healthcare provider to determine the best treatment for coughing up blood.

FAQs about the causes of coughing up blood

Is it normal to cough up a little blood with phlegm?

Blood in phlegm or red mucus is a normal symptom of cystic fibrosis and can be a sign of conditions like bronchitis and pneumonia. However, if there is more than a little blood (one to two teaspoons) in your phlegm, it’s best to see your healthcare provider as soon as possible.

Why am I coughing up blood only in the morning?

Hemoptysis occurring only in the morning may be due to blood draining from the sinuses or the nose to the back of the throat due to gravity while you are asleep. Chronic conditions like cystic fibrosis and COPD can cause hemoptysis. Sometimes, the blood is a symptom of an acute condition like pneumonia. If you’re coughing up blood at only certain points of the day, tell your healthcare provider—this can help them identify the source of the problem.

Should I go to the ER for coughing up blood?

Coughing up small amounts of blood is usually not life-threatening and is often a symptom of bronchitis or pneumonia. However, if you are coughing up large amounts of blood, the problem worsens, or you’re also experiencing shortness of breath, dizziness, racing heartbeat, chest or back pains, coughing up pure blood, or seeing blood in your urine or stool—it’s very important to seek immediate medical attention.

What’s next? Additional resources for people with hemoptysis

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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