Why Are You Coughing Up Pink Mucus or Phlegm?

Key takeaways:

• Pink phlegm gets its color from blood in the lungs or respiratory tract.
• Frequent coughing can cause a blood vessel to break and cause blood in your phlegm.
• Although coughing up a small amount of blood isn’t usually cause for concern, you should see your doctor if you often cough up large amounts of blood or pink phlegm.

Pink phlegm, or sputum, is caused by bleeding in the respiratory tract or lungs. Coughing up pink phlegm can occur if you have prolonged coughing, which can break fragile blood vessels in those two parts of your body. Common infections like pneumonia and acute bronchitis are also associated with coughing up pink mucus.

Occasional pink sputum is not uncommon and is not alwaysa cause for concern, but persistent pink sputum should prompt you to see your doctor. Additional symptoms like a fever, shortness of breath, and chest pain are signs that you should go to the emergency department. We’ll take a look at a range of causes and possible treatments below.

Is coughing up pink mucus or phlegm normal?

While coughing up pink mucus or phlegm isn’t necessarily normal, it is relatively common. A bad cough is usually the cause. If you have pink (or blood-tinged phlegm), you should consult your doctor to rule out any serious underlying disorders.

Causes of coughing up pink mucus

Pink, blood-tinged phlegm (hemoptysis) can occur in many different circumstances. In 20 to 50 percent of cases, though, the cause isn’t found. It can simply result from coughing, which can irritate or break a blood vessel in the air sacs in the lungs. Hemoptysis can also come from the sinuses, which drain into the throat and potentially the lungs..

Pneumonia

Pneumonia is an infection of the lungs caused by bacteria, viruses, or fungal organisms. The air sacs in your lungs become inflamed and can fill up with fluid or pus. Other symptoms of pneumonia are difficulty breathing, chest pain, fever, chills, and a productive cough (cough that produces mucus).

It’s common to experience chest pain with breathing or coughing. Young children, infants, older people, and people with compromised immune systems are more likely to develop severe cases of pneumonia.

Bronchitis and COPD

Bronchitis is an inflammation of the lining of your airways. A respiratory infection usually causes acute bronchitis. It usually comes on suddenly but improves within seven to 10 days. You may experience a fever, chills, shortness of breath, wheezing, sore throat, and discomfort in your chest. The cough may linger for a while after the other symptoms have subsided.

Chronic irritation of the airway lining is the primary symptom of chronic bronchitis. It is often caused by smoking and is one of the conditions associated with chronic obstructive pulmonary disease (COPD). If you have bronchitis repeatedly, you should see your doctor for evaluation. You may also experience increased mucus production, cough, shortness of breath, and fatigue.

Pulmonary embolism

A pulmonary embolism is a blood clot that’s lodged in the blood vessels of the lung. The clot usually forms in the deep veins of the legs and travels to the lungs, although clots can form elsewhere. Symptoms vary depending on where the clot lodges in the lung and how much of the lung is involved. If you have heart disease or another lung condition, your symptoms may be more severe.

You may experience sudden shortness of breath that worsens with exertion and sharp chest pain that prevents you from breathing deeply. Pulmonary embolisms sometimes cause sudden drops in blood pressure, which can result in lightheadedness or fainting. Coughing up pink phlegm, blood, or blood-streaked sputum can also occur. A pulmonary embolism is a life-threatening condition.

Heart failure with pulmonary edema

Heart failure occurs when your body is not pumping oxygenated blood to the rest of your body. This blood can back up in the pulmonary veins that return blood from the lungs to the heart. Fluid can then leak into the lungs, causing coughing with pink or white mucus.

You may experience shortness of breath, wheezing, and the feeling of suffocation. If you have heart failure, eating a lot of salty food can tip you into pulmonary edema. Pulmonary edema involves fluid buildup in the lungs.

Lung cancer

Although lung cancer occurs most often in people who smoke, many people who do not smoke develop lung cancer. Lung cancer usually causes a persistent cough, chest pain or discomfort, shortness of breath, weight loss, and blood in the sputum. Other types of head and neck cancer, such as throat or laryngeal cancer, may cause bloody phlegm.

Tuberculosis

Tuberculosis is a bacterial infection that affects the lungs, commonly leading to shortness of breath, fever, night sweats, weight loss, and bloody sputum. Some strains are resistant to antibiotics and require intensive treatment.

Granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA) is an autoimmune disease commonly known as vasculitis. Although it usually affects the lungs, sinuses, nose, and kidneys, vasculitis can affect any organ in the body.

Symptoms include sinusitis, rhinitis, mastoiditis, lung nodules, and bleeding in the air sacs of the lungs. People with this disease usually have kidney involvement. They may have a fever, weight loss, fatigue, muscle pain, and joint pain. Lung hemorrhages associated with vasculitis can cause bloody or pink sputum. Other rheumatologic diseases associated with hemoptysis include sarcoidosis and lupus.

Cystic fibrosis

Cystic fibrosis (CF) is an inherited disease that affects sweat- and mucus-producing parts of the body. Patients with CF have sticky, thick mucus, and their lungs are typically severely affected.

People with this condition develop frequent lung infections. Mucus can build up in the lungs, and the cilia in the airways that generally move mucus through the nose and mouth don’t work correctly.

Mitral valve stenosis

The mitral valve is one of the heart’s valves. It can become stenotic (narrowed) from various causes, including rheumatic fever, congenital heart disease, and calcification. Symptoms include shortness of breath, palpitations, chest pain, and hemoptysis. It is associated with a heart murmur.

Other possible causes of blood in your sputum include:

• Bronchiectasis (a disease of the airways that causes them to widen).
• Use of blood thinners.
• Inhaling cocaine.

Asthma and coughing associated with chronic acid reflux can also cause pink phlegm.

Other causes of coughing up pink mucus based on the mucus’s appearance or other symptom or situation

Phlegm is normally white, sometimes with a faint yellow tint. The exact color of your bloody mucus and the presence of other conditions can give you clues about the underlying cause.

Coughing up light pink phlegm

Light pink phlegm does not have a high concentration of blood. It is most commonly seen in pulmonary edema due to heart failure. Mild bronchitis and sinusitis are two other common causes.

Coughing up dark pink or red phlegm

If you are coughing dark pink or red phlegm, you may have significant bleeding. Tuberculosis, a tumor, or vasculitis (GPA) might be the cause. If your phlegm looks like blood mixed with yellow sputum or dark brown phlegm, it might be due to bacterial pneumonia or a sinus infection.

Diagnosing coughing up pink mucus

At your appointment, your doctor will ask if you have any symptoms accompanying the pink mucus. Your personal history and family medical history may also be relevant. The doctor will likely examine your throat and sinuses, check for enlarged lymph nodes, and listen to your lungs.

You may also need a chest x-ray, CT scan, or bronchoscopy. Depending on the suspected cause, your doctor may order blood tests.

Treatment options for coughing up pink phlegm

The most important treatment for pink or red mucus is treating the underlying cause. Pink mucus may resolve without any treatment. Home remedies and over-the-counter medications that alleviate symptoms may be all you need. In other cases, you may need antibiotics or medications only a doctor can prescribe.

Home remedies

One home remedy to soothe your irritated airway is to use a humidifier or vaporizer to break up any mucus in the sinuses or airways. It’s also important to stay hydrated. Drinking tea with honey may give your throat some relief.

Over-the-counter medications

Over-the-counter medications can soothe your irritated or inflamed tissues to help prevent coughing. These can include nasal rinses and cough suppressants. Decongestants and mucolytics can prevent the accumulation of mucus. If you have high blood pressure, ask your doctor before you take a decongestant.

When you should see a doctor about coughing up pink mucus

You can probably treat your pink mucus with home remedies or over-the-counter drugs if you don’t have any concerning symptoms. Concerning symptoms include high fever, weight loss, a large quantity of blood, shortness of breath, chest pain, and a persistent cough. These often warrant a trip to the doctor or emergency department.

You should see a doctor if you notice any of the following with your cough:

• Red phlegm
• Dark brown or yellow phlegm tinged with blood
• Persistent coughing and phlegm
• Fever and chills
• Weight loss

You should go to the emergency room if you notice any of the following with your productive cough:

• Shortness of breath
• Chest pain
• High fever
• Significant amounts of blood in sputum
• Wheezing
• Rapid or irregular heart rate
• Swelling in one of your calves
• Fainting or feeling faint

Questions to ask your doctor about coughing up pink mucus

• Should I be concerned about cancer or tuberculosis?
• I have asthma, but I’ve never coughed up pink mucus before. Why am I doing that now?
• What if my studies are normal, including blood work and chest X-rays?
• What should I do at home to help my symptoms?

Frequently asked questions: coughing up pink phlegm

Many people have questions about their symptoms. Here are some of the most frequently asked questions about coughing up pink phlegm or sputum:

What if you’re coughing up pink mucus only in the morning?

When you’re asleep, you don’t usually breathe as deeply as you do when you’re awake. Phlegm can build up in the airways and lungs as you sleep. As you awaken, the phlegm may start to break up, which can cause morning coughing.

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

If your cough with pink sputum is a new symptom and persists over a few days, you should see your doctor for evaluation.

Takeaway message: cough and pink phlegm

Coughing with pink phlegm is not unusual, and it’s not always a sign of lung cancer or heart failure. It is usually a symptom of a benign condition that resolves without treatment. You should see your doctor promptly if this is a new symptom that persists or if you have other symptoms like high fever, shortness of breath, weight loss, and dark-red or black sputum.

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. Jennifer Nadel, MD.

Sources

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"Problem: Mitral Valve Stenosis." www.heart.org, American Heart Association, 30 Sept. 2016, www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-mitral-valve-stenosis. Accessed 13 Nov. 2024.

Rout, Preeti. and Ahmad Qurie. “Granulomatosis With Polyangiitis.” StatPearls, StatPearls Publishing, 31 August 2024, https://pubmed.ncbi.nlm.nih.gov/32491759/.

Shah SN, Sharma S. “Mitral Stenosis.” [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430742/

Tobin EH, Tristram D. “Tuberculosis.” [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441916/

National Heart, Lung, and Blood Institute. "What Is Cystic Fibrosis?" National Institutes of Health, 13 Nov. 2023, www.nhlbi.nih.gov/health/cystic-fibrosis. Accessed 13 Nov. 2024.