Why Do You Have Bloody Phlegm, But No Cough?

Key takeaways:

• There are many possible causes of spitting or coughing up blood (known as hemoptysis)
• Symptoms like shortness of breath, wheezing, or fever may help pinpoint the underlying cause of hemoptysis.
• Hemoptysis may be chronic and develop over time, or acute, meaning its symptoms develop suddenly.

Phlegm isn’t exactly a common word – but most everyone is familiar with it. It’s a type of mucus that’s produced by the lungs; a thick, gel-like substance. Normally, you discover phlegm when you cough it up; it’s often a sign of an infection, like a cold or the flu. But sometimes you can tell your body is producing more phlegm than usual because it’s stuck in your throat. You haven’t been coughing a lot, but you cough to get rid of it. If you notice blood mixed in with the phlegm, this can be especially concerning.

The medical term for spitting or coughing up blood is hemoptysis. Causes of the condition vary, based on factors like how long you’ve had symptoms, your past medical history, travel history, and medications, among other factors. Causes can be further categorized based on more severe symptoms like shortness of breath, wheezing, and fever. If you’re noticing blood in phlegm without coughing, and you’re also experiencing other symptoms, be sure to see your doctor for evaluation and treatment options.

Is bloody phlegm without a cough normal?

Although hemoptysis isn’t always serious, it would not be considered “normal.” How severe the condition is depends on the underlying cause and the severity of your symptoms.

Causes of blood in phlegm without a persistent cough

There are many causes of blood in phlegm that don’t necessarily involve coughing. These include lung diseases; infections; vascular disorders (affecting blood vessels, veins, or arteries); and inflammation (swelling and irritation) of the lungs or airways.

Bronchial diseases

Conditions that affect the bronchi (airways) of the lungs are known as bronchial diseases. One of these is bronchitis, which is inflammation of the bronchi. Bronchitis can be either an acute (sudden onset) or chronic (longer-term) condition. Flare-ups of bronchitis can be triggered by an underlying lung condition (such as cystic fibrosis), an underlying immune condition (such as an immunodeficiency), or other types of infections.

A separate but related lung condition is bronchiectasis (brahn-kee-EHK-tuh-sis). It may develop after an infection damages the lungs, which causes the airways to widen. This damage leads to chronic changes that affect the drainage of mucus and cause airway obstruction. These changes affect the cells of the lung on a microscopic level. They also cause scarring of the larger airways and structures of the lungs.

If you suffer from bronchitis or bronchiectasis, you will likely have hemoptysis, too. In people with either (or both) of these conditions, it is common to see minor amounts of blood-streaked mucus or phlegm. You may or may not have an accompanying cough.

Chronic obstructive pulmonary disease (COPD)

Bronchitis and bronchiectasis are two of many lung conditions that cause hemoptysis. Many other conditions lead to it as well, such as chronic obstructive pulmonary disease (COPD). It harms your lungs by impairing their ability to remove carbon dioxide as you exhale.

As its name indicates, COPD is a chronic condition, but you may have acute episodes of it. During these episodes, you may experience bloody phlegm. Other symptoms include shortness of breath, wheezing, and sometimes coughing.

Infections

Infections have played a large role in driving many of the changes in the previously discussed conditions. Although an isolated infection may not lead to such long-term changes, frequent infections (and improperly treated infections) can lead to them. These result from chronic inflammation and structural changes in the lungs. Lung infections are common, including viral infections like respiratory syncytial virus (known as RSV), influenza virus, and COVID, among others.

Although similar to viral infections, bacterial infections are typically worse. Pneumonia, an infection of the lungs, can cause hemoptysis. If you are diagnosed with bacterial pneumonia, you’ll probably need antibiotics to clear up the infection. If you have a recent travel history outside the U.S., you may also be at increased risk for other infections, such as tuberculosis. These various infections can all cause hemoptysis.

Vascular disorders, bleeding or trauma, or cancer

Like all the organs in your body, your lung function is dependent on having well-functioning blood vessels and circulation. If any conditions affect the blood vessels that supply your lungs or airways, it can lead to inflammation or irritation that can cause hemoptysis. Similarly, you may have bleeding from lung tissue or even a clot in the lungs (known as a pulmonary embolism).

It is possible that your hemoptysis is a warning sign of a more serious condition, such as cancer. If you have associated symptoms of fatigue, unintentional weight loss, or night sweats, or if you have a family history of cancer, speak with your doctor for further evaluation.

Other causes of bloody phlegm without a cough based on another symptom or situation

This section focuses on associated symptoms with your bloody phlegm that may suggest a specific cause.

Bloody phlegm, no cough, and a sore throat

If you have a sore throat along with hemoptysis, it suggests an infection. This may be pharyngitis (inflammation of the pharynx, or throat) or another inflammatory condition.

Bloody phlegm and no cough during pregnancy

Pregnancy can cause significant hormonal changes. If you are experiencing hemoptysis during pregnancy, speak with your obstetrician for further evaluation.

Diagnosing bloody phlegm without a cough

A doctor will take a comprehensive history in addition to physical exam findings to narrow the likely cause of your symptoms. They may include blood work, sputum cultures, or imaging studies to identify the underlying cause of your bloody phlegm.

Treatment options for bloody phlegm without a cough

Hemoptysis can be scary. Although you should always speak with your doctor if you’re concerned, you can try some of the treatment options here to see if your symptoms improve.

At-home remedies

Your bloody phlegm may be due to irritation and dryness of your sinuses, airway, or lungs. If you notice that your nose or throat feels dry, drink lots of fluids. Staying well-hydrated can help prevent any irritation that may have led to your symptoms. Similarly, taking a hot shower can bring relief; steam can help moisten the membranes in your sinuses. It can also help break down any mucus or phlegm that may have been stuck in your lungs, airways, or sinuses. Another idea is to use a humidifier in your home.

Cough suppressants

Numerous over-the-counter cough-suppressing medications are available, such as Robitussin or Delsym. If you have noticed that your hemoptysis occurs after a forceful coughing spell, these medications may help.

Antibiotics

If you have a fever along with hemoptysis, you may have developed an infection. Be sure to get further evaluation from your doctor. You may need antibiotics or other medications to help clear the infection and prevent long-term complications.

When you should see a doctor about bloody phlegm

While you should always feel comfortable contacting your doctor when you have concerns, sometimes it’s especially important to do so. If you notice any of the symptoms listed here, be sure to seek further evaluation from a healthcare professional.

You should see a doctor if you:

• Have a fever with a temperature greater than 100.4℉;
• Have worsening phlegm production and notice there’s more blood in in the phlegm;
• Develop shortness of breath or wheezing;
• Were recently hospitalized for any reason;
• Have a family history of lung conditions or lung cancer;
• Have a history of smoking;
• Experience unintentional weight loss;
• Are not up-to-date with your immunizations.

You should go to the emergency room if:

• You’re having trouble breathing;
• Your skin turns a blueish color;
• You develop chest pain;
• You lose consciousness or faint;
• You’re not able to keep anything down, including liquids or food;
• You’re coughing up bright red blood.

Questions to ask your doctor about bloody phlegm without a cough

• Should I have imaging done, like a chest X-ray, ultrasound, CT scan, or MRI?
• Are there any tests that can help identify the cause of my symptoms?
• Should I get a laryngoscopy or a bronchoscopy?
• What medications could help improve and resolve my symptoms?

Frequently asked questions: bloody phlegm without a cough

If you’re experiencing bloody phlegm, you probably have many questions. Here are some of the most frequently asked questions regarding this medical issue.

How long can you have bloody phlegm without a cough before you should be concerned?

If it’s occurring on and off, it may be a short-term symptom. If you notice that your symptoms persist or worsen over a few days, be sure to speak with your doctor.

What if you only have bloody phlegm without a cough in the mornings?

If you notice a definite pattern and timing of your symptoms, there may be a specific trigger. Start keeping a log of your symptoms. Also, consult with your doctor to see if there’s a consistent pattern that would help identify the cause of your symptoms.

What if you have bright red phlegm?

This may suggest bleeding in your throat, airways, or lungs, and merits a trip to the emergency room.

Managing bloody phlegm without a cough

Hemoptysis can be a frightening symptom. So if you notice persistent or worsening symptoms, be sure to seek guidance and further evaluation from a healthcare provider. If necessary, seek treatment at an emergency room.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Adam Carewe, MD.

Sources

Beth Oller, MD (reviewer), “Chronic Bronchitis,” Familydoctor.org, November 2024. familydoctor.org/condition/chronic-bronchitis.

Deepak S. Patel, MD (reviewer), “Pneumonia,” Familydoctor.org, November 2024. familydoctor.org/condition/pneumonia.

Robert “Chuck” Rich, Jr., MD (reviewer), “RSV in Adults Over 60,” Familydoctor.org, October 2024. familydoctor.org/condition/rsv-in-adults-over-60.