Patients with lung disease can experience many scary things, including feeling short of breath, inability to cough up phlegm, chest pain and lightheadedness. Another less common symptom is coughing up blood. The medical term for this is hemoptysis. Coughing up blood can be a particularly alarming experience. Usually it is painless. Your doctor will ask if the blood is bright or dark and whether it is mostly blood or mixed with mucous. Also important is the quantity—a teaspoon, tablespoon or cups at a time. At times a nose bleed can be mistaken for coughing up of blood.
In general, coughing up blood is not a typical or common occurrence for patients with IPF. Some of the other causes of fibrosis, and other types of problems in the lungs may be more prone to develop this problem. The most common cause of coughing up a small amount of blood mixed with phlegm is bronchitis. This may be viral, bacterial or due to smoking. The general approach to this problem is to treat the underlying bronchitis. Inhaled medications such as albuterol, cough suppressants and even prednisone can be tried. Antibiotics are often prescribed but of unclear benefit.
Patients that have bronchiectasis (abnormal dilation of the small airways of the lungs) are particularly prone to coughing up blood. This can become a serious problem very quickly and should prompt you to seek urgent evaluation. Treatment is often antibiotics, inhaled medications and cough suppression.
Patients that have chronic fungal or cavitary lung disease may experience abrupt large volume coughing up of blood. This is an emergency. Patients should be seen in an emergency department immediately. Management may involve urgent embolization (blocking off of the bleeding vessels). Surgery is sometimes required.
Fortunately, for most patients with IPF, coughing up blood is very rare.