Why Are You Coughing Up Bloody Mucus or Phlegm?

Key takeaways:

• Not all causes of bloody mucus are serious, but persistent or large amounts always require medical evaluation.
• Additional symptoms and medical history help determine whether the cause is benign or requires urgent attention.
• See a doctor if you’ve been coughing up blood for more than a few days, or go to the ER for severe symptoms like chest pain or shortness of breath.

Coughing up bloody mucus, a condition referred to in the medical world as hemoptysis, can be concerning. The cause can range significantly from benign to an indication of something more serious. Understanding the causes of this symptom is essential for determining when you should worry. In this article, we will explore the common causes of coughing up bloody mucus, when to see a doctor, and the available treatments.

Is coughing up bloody mucus or phlegm normal?

You should not automatically write off coughing up bloody mucus or phlegm as normal, but there are cases where it may be benign. Some causes of blood mucus, including the less serious causes will be reviewed below. Coughing up a large volume of blood over a frequent and chronic period is never considered normal.

Causes of coughing up bloody mucus

Coughing up bloody mucus can have a variety of causes, ranging from minor irritations to serious conditions. Below are some of the most common reasons people experience this symptom

Respiratory tract infections

Respiratory infections such as the common cold, bronchitis (inflammation in the lungs), and pneumonia are some of the most frequent causes of coughing up bloody mucus. Infections can cause inflammation in the airways, leading to irritation and rupture of superficial blood vessels. These infections can lead to mucus having streaks of blood in it or appearing blood-tinged.

Chronic respiratory conditions

Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis lead to long-term inflammation in the airways and irritation of pulmonary blood vessels. The persistent coughing and inflammation associated with these conditions can cause blood vessels in the lungs to break, leading to blood in the mucus. Smokers are at risk of developing COPD.

Tuberculosis

Tuberculosis (TB) is a bacterial infection that primarily affects the lungs. Symptoms include coughing with or without bloody mucus, weight loss, and fever. Bleeding occurs as a result of ulceration into the vessels in the lungs. Although TB is less common in developed countries, it is still a concern for individuals with weakened immune systems or those living in close quarters and house communities.

Lung cancer

Studies show that up to 20% of cases of coughing up bloody mucus are the result of an underlying lung cancer. There are many different types of lung cancers, but squamous cell lung cancers are most likely to cause hemoptysis. Tumors in the lungs can lead to erosion of lung tissue and blood vessels, allowing for blood to accumulate and appear in the phlegm. The amount of blood in the phlegm as a result of lung cancer can range from a small to a massive amount.

Other causes of coughing up bloody mucus back based on the mucus’ appearance or other symptoms or situations

Coughing up bloody mucus can alert your doctor that something serious may be going on. But to narrow down the potential cause, you must look beyond the blood alone and examine other aspects of the mucus.

Coughing up thick or hard bloody mucus

Thick or hard mucus is usually the result of any condition that causes your body to produce excess mucus. Respiratory infections caused by bacteria, viruses, and fungal infections can cause thick or hard mucus. Chronic conditions such as COPD can also be responsible. As previously discussed, these infections and chronic conditions can irritate blood vessels, which leads to bloody mucus.

Coughing up green bloody mucus

There is a long-standing myth that green mucus equates to an infection. Now would be a good time to point out that the color of your mucus does not always indicate an infection, and it is possible to have a bacterial or viral lung infection and cough up clear or yellow mucus. Green mucus is actually due to an enzyme that your body produces to repel irritants (both infectious and not) that enter the respiratory tract.

Coughing up brown bloody mucus

Brown mucus may indicate older blood stemming from somewhere within the respiratory tract. This could be the result of chronic lung conditions or lung cancer and warrants further evaluation.

Coughing up bloody mucus in the morning only

Coughing up blood in the morning is often associated with chronic conditions like COPD, where the mucus accumulates in the lungs overnight and is expelled first thing in the morning.

Coughing up bloody mucus with a sore throat

This is likely due to an upper respiratory tract infection that causes irritation and inflammation to the throat and lungs and potentially causes bleeding from superficial blood vessels. Acid erosion from acid reflux should also be considered, as this can cause a sore throat and a cough.

Coughing up bloody mucus with a cold or the flu

Viral infections that cause a cold or the flu can lead to irritation within the respiratory tract. Persistent coughing, irritation, and inflammation can lead to the rupture of superficial blood vessels and small amounts of blood to be seen in the mucus.

Coughing up bloody mucus with COVID

Generally speaking, coughing up bloody mucus is not a major symptom associated with COVID. Studies have found that only about 2.3% of severe cases of COVID-19 result in bloody mucus due to bleeding within the small air sacs of the lungs.

Diagnosing coughing up bloody mucus

There are several diagnostic studies that your healthcare provider may use to diagnose the cause of coughing up bloody mucus. Initially, they will likely order a chest x-ray or a CT scan of the chest due to their minimally invasive nature. If these studies are not diagnostic, they may analyze the phlegm to look for causative organisms or a bronchoscopy, which allows your provider to look directly into your lungs for abnormalities.

Treatment options for coughing up bloody mucus

Treatment for coughing up bloody mucus depends on the underlying cause. Below are some common approaches to try either at home or with the guidance of your healthcare provider.

At-home remedies

Managing the symptoms at home is often sufficient if the cause is an acute infection like a cold or acute bronchitis. Rest, increasing hydration, and using a humidifier to reduce inflammation in the airways are all helpful at-home steps.

Medication

If you are diagnosed with a bacterial infection such as pneumonia, your doctor may prescribe antibiotics to target your infection. Additional medications such as steroids, cough suppressants, and expectorants may be used for symptom management. Antibiotics are also necessary in the rare but potential case of tuberculosis.

Surgical interventions

In more serious cases, surgery may be necessary. If a massive source of bleeding is identified, a procedure may be needed to control the bleeding. Surgery may also be required to remove lung cancer tumors.

When you should see a doctor about coughing up bloody mucus

If you are coughing up bloody mucus, you should not ignore this symptom. With the exception of mild blood-tinged phlegm due to an acute infection, this symptom should always be evaluated by your doctor.

You should see a doctor if:

• You have been coughing up blood for more than a few days.
• You have a history of smoking or lung disease.
• You believe you may need an antibiotic for an upper respiratory tract infection.

You should go to the emergency room if:

• You are coughing up large amounts of blood.
• You are experiencing other symptoms like chest pain or shortness of breath.
• You are feeling weak or dizzy.

Questions to ask your doctor about coughing up bloody mucus

• What could be causing my symptoms?
• Should I be concerned that I have lung cancer?
• What tests will you use to diagnose the cause of my symptoms?
• What can be done to stop or treat this symptom?

Frequently asked questions: coughing up bloody mucus

If you are coughing up bloody mucus, you will most likely have questions. Here are some of the most commonly asked questions about this symptom.

Can a dry throat cause bloody mucus?

Extremely dry airways, including the nose, throat, and respiratory tract, can lead to irritation and bleeding from superficial blood vessels. Using a humidifier, particularly in dryer climates, can help reduce the likelihood of this symptom.

What if you’ve been coughing up bloody mucus but don’t have a cough?

If you are producing bloody mucus without a cough, this may indicate a more serious condition like lung cancer and should be evaluated by a healthcare provider as soon as possible.

What if you’ve been coughing up bloody mucus for a week or longer?

If you have been coughing up bloody mucus for more than a week, it is very important that you see your healthcare provider for a thorough evaluation and workup.

Managing bloody mucus

Although unsettling, it is important to remember that coughing up bloody mucus can be caused by various factors, some of which are benign and easily treatable. If you are unsure about the cause of your symptoms or if the blood persists, a consultation with your healthcare provider is always your best option.

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. Pallabi Sanyal-Dey, MD.

Sources

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Singer, Emad D et al. “Hemoptysis in Cancer Patients.” Cancers vol. 15,19 4765. 28 Sep. 2023, doi:10.3390/cancers15194765 https://pmc.ncbi.nlm.nih.gov/articles/PMC10571539/#:~:text=Approximately%2020%25%20of%20hemoptysis%20cases,obstruction%20and%20hemoptysis%20%5B54%5D.

“Symptoms - Chronic Obstructive Pulmonary Disease (COPD).” NHS, NHS, 11 Apr. 2023, www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/symptoms/. Accessed 10 Nov. 2024.

Takahashi, T et al. “Fatal diffuse alveolar hemorrhage caused by acute COVID-19 infection in an unvaccinated patient.” QJM : monthly journal of the Association of Physicians vol. 116,7 (2023): 521-522. doi:10.1093/qjmed/hcad018 https://pubmed.ncbi.nlm.nih.gov/36727497/