Dean Cruikshank

Hemoptysis

People with CF can cough up blood. The medical term for this is hemoptysis. Chronic lung infection leads to enlargement of the blood vessels (called bronchial arteries) in the lung which can become weak and burst releasing blood into the airway. Although the leak in the blood vessel will close up in the normal clotting process, there is no place for the blood in the airway to go except to be coughed up in the sputum. Usually hemoptysis means that you are having an infection. It is important that you report hemoptysis to your CF team in order to decide if you need antibiotic therapy for infection. Hemoptysis of large amounts of blood is not common but can be serious and potentially life threatening. In severe cases of hemoptysis, it is sometimes necessary to carry out a medical procedure to stop the bleeding known as bronchial arterial embolization. Your CF team can give you advice about what you should do if you cough up blood. Usually when individuals cough up blood we recommend that they hold any inhaled antibiotics or inhaled medications to thin the mucous until the bleeding has stopped for 24 hours. Taking inhaled ventolin is safe to continue even if you are having hemoptysis.

Coughing up blood is usually indicative of more infection in the lungs in people with CF. On top of that, the blood in our airways is like mucus in our airways. Thus, it is logical to do more airway clearance therapy. There has never been any report that airway clearance therapy will lead to and/or increase bleeding from the lungs. Also, there are not any scientific studies on physiotherapy management at the time when an individual is coughing up blood.

It is vital to continue with airway clearance and exercise, while ensuring no worsening of the bleeding in the lungs. Here is a summary of the guidelines/recommendations based on a consensus of expert opinions from physiotherapists with significant clinical experiences in CF.