Bloody expectoration - causes and therapy

Bloody expectoration - causes and therapy

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Bloody sputum when coughing usually causes great terror. Not without reason, because the blood admixture in the secretion can be an indication of a serious illness of the respiratory tract and should therefore be taken seriously in any case.

In addition to this, relatively harmless causes such as inflammation of the gums or inflammation of the bronchi can be the trigger. In order to avoid any health risk, a prompt medical examination is urgently advised. This is the only way to avoid health hazards and to initiate the necessary treatment steps immediately. If there is a lack of clarity or doubts about the cause, an emergency doctor should always be called, especially in the case of complaints such as shortness of breath, circulatory problems, rapid heartbeat and / or chest pain.

Definition: what is bloody sputum?

The term “bloody sputum” is usually used to refer to lighter blood in the secretion (sputum), which is released from the body through coughing. Accordingly, it is a certain form of "coughing up blood", which is medically referred to as "hemoptysis". In contrast to this, larger amounts of blood are directly coughed out in the case of the "hemoptysis". The blood admixture can be very different and accordingly appear from light pink to light red to deep rust brown. In addition, it can be of different strengths, so that sometimes only small red dots or traces can be seen. In other people, however, it seems as if the secretion is "streaked" with blood threads.

Regardless of the manifestation, any sign of blood in the sputum should be immediately consulted with a doctor who can clarify the cause and take appropriate further steps. This is very important because coughing up blood, like vomiting blood (hematemesis), often indicates serious health problems and can be an important sign of a potentially life-threatening illness.

Causes of bloody sputum

There are various reasons for bloody additions to the sputum. In some cases there are relatively harmless causes such as Bleeding gums or nose, and bleeding can also be caused by an injury to the mouth. More often, bloody secretions have a more serious background, such as chronic bronchitis or COPD or pulmonary embolism. Therefore, a doctor should always be consulted immediately in the event of an undetectable or unclear trigger and any form of uncertainty.

Acute bronchitis

A possible reason for bloody secretions can be severe, acute bronchitis. This term medically describes inflammation of the mucous membranes in the bronchi, which is usually associated with inflammation of the upper airways (nasal and pharynx). It is one of the most common diseases and affects around 80 out of 100,000 inhabitants per week, with this number usually doubling in the winter months.

Acute bronchitis can be triggered by various causes, but mostly there is a viral infection (e.g. with influenza, rhino or corona viruses). Rarely, bacteria, fungi or chemical stimuli can cause the disease, and the inflammation can also occur in connection with other infectious diseases (such as measles). The main characteristic of acute bronchitis is a strong, initially dry cough, which is often accompanied by a cold. If the virus spreads further, fever and other typical cold symptoms such as headache, limb and sore throat, hoarseness, burning sensation in the chest, fatigue and night sweats are added.

After a few days the so-called "productive" cough develops, whereby the expectoration initially appears viscous and whitish-clear. Later, this can also take on a yellowish or green color due to an additional bacterial infection ("super infection"). In severe cases, there may also be slight additions of blood, which is due to minor injuries to the mucous membranes and, accordingly, does not normally cause any concern. Nevertheless, as a precaution, the bloody sputum should always be clarified by the doctor.

Bloody sputum from pneumonia

In addition, severe pneumonia can be the reason. This is an acute or chronic inflammation of the lung tissue, which is usually caused by an infection with bacteria or especially by so-called "pneumococci". Viruses, fungi or parasites can also rarely trigger the disease, whereby primarily immunodeficient people (e.g. after an organ transplant or with HIV) are affected.

The symptoms of pneumonia are similar to bronchitis and usually begin with breathing problems, shortness of breath and a strong cough. The sputum is yellow-green, brownish or slimy-purulent; in more severe cases, blood admixtures can also be seen. In addition, there is typically a high fever, chills and chest pain as well as non-specific complaints such as fatigue and exhaustion, limb and headache. Inflammation of the lungs should not be underestimated and can be a life-threatening danger. The disease poses an increased risk, especially for babies or toddlers, senior citizens and immunocompromised patients. In young and healthy people, on the other hand, the body's immune system is usually strong enough to fight the pathogen.

Legionnaires' disease

A particularly severe form of pneumonia is the so-called "legionellosis" or "legionnaires' disease", which can also be accompanied by bloody sputum. In this case, the inflammation is triggered by bacteria of the genus Legionella (Legionella pneumophila), which spread and multiply primarily in warm fresh water (20 to 55 degrees). However, the infection is not caused directly by Legionella in the water, but via atomized water (aerosol), e.g. when showering, in whirlpools, through inhalers or humidifiers at the workplace. Legionnaires' disease usually initially causes more general symptoms such as high fever, chills, headache and body aches. In addition, there may be chest pain, shortness of breath, irritable cough with blood in the sputum, sometimes abdominal pain, diarrhea and vomiting also occur.

Cough secretion with blood in pulmonary embolism

A very serious reason for the bloody expectoration can be pulmonary embolism. Although this is not always life threatening, according to the German Society for Angiology - Society for Vascular Medicine e. V. (DGA) up to 100,000 people a year in Germany alone. This makes pulmonary embolism the third most common cause of death in vascular medicine after a heart attack and stroke.

In most cases, the starting point for pulmonary embolism is a vascular occlusion (thrombosis), whereby the deep leg or pelvic veins are particularly often affected. Age is one of the main risk factors for thrombosis, as is e.g. blood poisoning, heart failure or a previous heart attack. In addition, the risk increases e.g. after surgery, prolonged bedriddenness, through pregnancy and the puerperium or through certain medications and hormones (such as the birth control pill)

If there is a brood clot, parts of what may happen immediately after getting up in the morning as a result of pressure fluctuations in the vascular system (e.g. due to strong pressing during bowel movements) can sometimes come loose. This so-called “embolus” can get through the bloodstream to the heart and from there to the lungs and, depending on its size, partially or completely close a vessel there. As a result, the blocked area of ​​the lungs is no longer sufficiently supplied with blood, which can cause different symptoms depending on the size of the embolus and the affected vessel.

While a smaller embolism causes only minor problems and often even goes unnoticed, severe complaints occur suddenly when a larger vessel is closed, such as sudden breathing and breathlessness, chest pain, sweating and fainting, which are suddenly faster. There is also often fear and a feeling of anxiety, rapid heartbeat and cough with expectoration, in which small amounts of blood can be seen. In the case of a massive pulmonary embolism, there is an acute risk to life, because the severe impairment of the blood circulation in the heart and lungs can lead to cardiac arrest, which in most cases ends fatally without early intervention. Accordingly, an emergency call must be made immediately if suspected pulmonary embolism.

Bloody sputum in the morning / COPD

Another possible cause is the so-called "chronic obstructive pulmonary disease", which is briefly referred to as "COPD" (abbreviation of the English name "Chronic obstructive pulmonary disease"). Various chronic respiratory diseases are summarized under the term COPD, the common feature of which is an increasing blockage of the air flow in the lungs (obstruction). As a result, there are the typical COPD symptoms of shortness of breath, cough and expectoration ("AHA" symptoms), which is why the disease is often colloquially referred to as "smoking cough" or "smoking lung".

The morning cough is usually particularly pronounced, often associated with expectoration. This is usually colorless, but can also be yellowish green or brown in the case of infections, and may contain small amounts of blood due to the permanent inflammation. In addition, there is increasing difficulty in breathing over time and other complaints such as a reduced performance, low resilience, fatigue as well as whistling or humming noises when breathing. As a result, simple everyday things like climbing stairs or carrying shopping can often become difficult and become an ever greater problem. COPD is therefore by no means just a "harmless" smoker's cough, but is a life-threatening lung disease that can lead to fatal complications such as heart failure (cor pulmonale).

The disease is primarily characterized by chronic obstructive bronchitis and / or the so-called “pulmonary emphysema”. In the run-up to COPD, most of those affected suffer from simple chronic bronchitis, which, however, does not mean that the airways are permanently narrowed and is therefore in principle still reversible. If the cause of chronic bronchitis (such as smoking) is not eliminated, chronic obstructive bronchitis and thus COPD can develop in the further course. In this case, the changes in the lungs can no longer be reversed, instead there is a narrowing of the bronchial tubes, which causes more and more shortness of breath (dyspnea) during exercise and later also when at rest.

In addition, due to the permanent inflammation, the walls of the alveoli (alveoli) can be attacked and destroyed. As a result, the small blisters merge into larger blisters, causing pathological bloating of the lungs and ultimately an irreversible decrease in lung function.

The main cause of COPD is cigarette smoking, around 90 percent of all those affected are smokers or former smokers. In rare cases, years of inhaling other harmful substances such as toxic dust, vapors or toxic liquids can be the trigger. Accordingly, the COPD is e.g. now even recognized as an occupational disease in coal mining ("miner's bronchitis"). Exhaust gases and particulate matter as well as genetic factors (such as an alpha-1-antitrypsin deficiency) can also promote the disease.

Blood in the sputum in lung cancer

In very serious cases, lung cancer (lung carcinoma) or bronchial carcinoma can also be the cause of the blood in the sputum. It is a tumor that affects around 50,000 people in Germany every year. It is suspected that many different factors are responsible for the development of lung cancer, and often no concrete trigger can be found in those affected. However, some factors are known that significantly increase the risk and should be avoided accordingly. These primarily include smoking and passive smoking, but also e.g. asbestos, radiation exposure through medical examinations (e.g. frequent X-rays) or air pollutants such as diesel soot.

The particularly tricky thing about the disease is that the cancer does not cause pain. Instead, typical symptoms appear late, which means that the disease is often only discovered at an advanced stage. Therefore, warnings for lung cancer should be taken particularly seriously and immediately checked with a doctor. These include persistent coughing for more than four weeks as well as mucus and secretions with blood admixtures. Even the tiniest blood traces that occur only once can be an important signal. Chest pain or a stinging in the chest, which can occur both when breathing, coughing, at rest and when under stress, should under no circumstances be ignored. In addition, cancer signs and symptoms such as fever, night sweats, listlessness, increasing exhaustion, breathing problems and unwanted weight loss usually appear in advance for a longer period of time.

Treatment for blood admixtures in the secretion

If the doctor was able to diagnose uncomplicated bronchitis, no special treatment is usually required. In general, however, the consumption of tobacco should be avoided and (especially in the case of fever) care should be taken to ensure adequate rest and protection. Depending on the symptoms, e.g. Inhalations, pain relievers such as paracetamol or short-term use of cough suppressants (antitussives) help, if there is a bacterial superinfection, the doctor usually prescribes antibiotics.

In the case of pneumonia, therapy is carried out in many cases (severe form of pneumonia, elderly patients, existing comorbidities, etc.) in the hospital. Special drugs are usually used to combat the causative agents, e.g. Antibiotics or antifungals. If there is severe shortage of air, the addition of oxygen may also be necessary. If the patient is young and healthy, the disease usually heals without consequences within about six weeks. However, if there is a weakened defense, the healing process can take a lot longer. Complications such as blood poisoning, inflammation of the heart (pericarditis) or a blood clot, which can be life-threatening under certain circumstances.

In the case of legionnaires' disease (legionellosis), it is particularly important that therapy begins as early as possible, since the disease can become life-threatening, especially for older and chronically ill people. Accordingly, at best, a doctor should be consulted immediately if an infection is suspected. If the patient is actually infected with Legionella pneumophila, an antibiotic (e.g. levofloxaci) is usually used for about one to three weeks. It is also essential to prevent the spread by eliminating the source of the infection (such as ailing water supply systems).

If you have chronic obstructive pulmonary disease (COPD), the most important step in preventing further progression of the disease is to eliminate the risk factors. Accordingly, immediate smoking cessation is necessary in most cases, sometimes with heavy exposure to dust, gases, vapors, etc. a change of job should also be indicated. Drug therapy also serves to alleviate the symptoms and avoid life-threatening complications. Depending on the stage of the disease, various agents are used, which are primarily intended to expand the airways and accordingly improve breathing (bronchodilators).

In the case of acute worsening (exacerbations), antibiotics are normally used for bacterial infections. If COPD is very advanced, long-term oxygen therapy (LOT) is often indicated, in which oxygen is supplied to the patient using so-called “nasal cannula”. In addition to this, a number of other non-drug measures are available. These include e.g. Patient training, inhalations, physical training, certain breathing exercises or the learning of breathing-easing body positions as part of physiotherapy.

In the case of lung cancer, the therapy depends crucially on the type of lung cancer (non-small cell or small cell) and the stage at which the disease is at the time of diagnosis. In addition, the age and general state of health as well as possible previous diseases of the patient's lungs play a central role. Depending on the case, local (surgery, radiation therapy) or systemic therapy methods (e.g. chemotherapy) are used, which are often combined. In addition to this, there are various approaches that can positively influence the course of the disease. This includes, among other things, strengthening the general condition through a wholesome diet and psychological suppression by appropriate experts in order to be able to cope better with the disease.

Therapy and prevention for pulmonary embolism

If there is suspicion of pulmonary embolism, this must be clarified immediately. Because only a quick diagnosis and treatment can prevent the course of the disease. Accordingly, the emergency doctor should be informed immediately, who, depending on the symptoms, first administers painkillers, sedatives or circulatory stabilizing drugs. The further steps are then usually carried out in the hospital according to the severity of the embolism. Here comes e.g. in less severe cases, treatment with anticoagulant drugs (heparin) may be considered. In the case of heavier occlusions, drugs can be used that dissolve the blood clot and thus ensure an uninterrupted blood flow ("lysis therapy"). Mechanical clotting of the blood clot using catheter treatment and removal by open surgery (pulmonary embolectomy) are also possible.

Pulmonary embolism is usually caused by the occlusion of a vein in the pelvis or leg. Accordingly, the most important preventive measure is to effectively prevent thrombosis. On the one hand, it is important to observe certain general measures, e.g. in the case of an illness, bed rest is only maintained for as long as it is really sensible and helpful. Even after surgery, the patient should be mobilized again as early as possible to reduce the increased risk of being bedridden for a long time. In addition to e.g. Compression bandages or so-called "thrombosis stockings" before and after the procedure or after childbirth improve blood flow and thus counteract a clot.

Smoking cessation, the reduction of excess weight and sufficient drinking are also important, and vein gymnastics (e.g. foot circles or seesaws) can also be a useful prevention. In general, attention should always be paid to sufficient exercise. On longer trips e.g. by plane or train, it is advisable to "stretch your legs" from time to time or alternatively to perform vein gymnastics at the square.

In addition, pulmonary embolism or recurrence with anticoagulant medication (anticoagulants) can be prevented. Here are active ingredients such as Dalteparin, rivaroxaban or danaparoid.

Home remedies and naturopathy for coughing up blood

Home remedies and alternative healing methods are only used to a limited extent for bloody expectoration, because many underlying causes (e.g. pneumonia, bronchial carcinoma) require fast and intensive medical treatment and the use of certain medications. Accordingly, any form of blood in the sputum should be taken seriously and examined medically in order to be able to clarify the trigger exactly.

However, if the cause is e.g. diagnosed with bronchitis, naturopathy can be used as a support. If you have a convulsive cough, e.g. a thyme breast wrap question. For this, a tea is first brewed from two teaspoons of thyme herb and 500ml liters of boiling water and left to steep for five to ten minutes. Then a cotton cloth is soaked in it and wrapped around the chest after a short cooling. Another cotton cloth and a warming wool scarf come over it. If the wrap feels cold on the skin, it is removed again.

Another proven home remedy for bronchitis is inhalation, which helps loosen the mucus and make it easier to cough up. It is advisable here, e.g. twice a day inhale with sea salt, whereby a 0.9% salt solution (9 grams of salt per liter of water) has proven itself. As another effective home remedy for cough, various herbal teas can be a beneficial aid. Depending on the symptoms, e.g. for expectoration and coughing a combination of marshmallow root, Icelandic moss and licorice root (20/40/40 grams). Two teaspoons of the mixture are scalded with 250 ml of boiling water and left to steep for ten minutes. (No)

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. Social Science Nina Reese


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

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