Aetiology, diagnosis and treatment of moderate-to-severe haemoptysis in a North American academic centre

Abstract

Significant haemoptysis is a frightening event for patients and clinicians alike. There is a paucity of contemporary literature on the subject.A retrospective analysis of hospitalisations for haemoptysis of more than 50 mL·day−1 in a tertiary referral centre during a 5-year period was performed. Patient's characteristics, haemoptysis aetiology, management and outcome were individually recorded. The aim of this study was to detail the causes of moderate (50–200 mL·day−1) to severe (>200 mL·day−1) haemoptysis along with the diagnostic measures and treatment options used in their management in a 21st century, tertiary-care North American centre.A total of 165 hospitalisations for moderate-to-severe haemoptysis were included in the analysis. Lung cancer (30.3%) and bronchiectasis (27.9%) proved to be most frequent aetiologies. Computed tomography (CT) imaging and bronchoscopy were complementary in identifying the source of bleeding. Bronchial artery embolisation (BAE) was the most common treatment approach (61.8%) and resulted in initial bleeding control in 73.5% of cases. In-hospital mortality was 13.9%, varying from 3.3% in the moderate group to 24.7% in the severe group. Despite being the favoured approach in patients with more severe bleeding, initial BAE therapy was associated with a trend towards lower mortality compared to initial non-BAE therapy.In summary, lung cancer and bronchiectasis were the main causes of moderate-to-severe haemoptysis in our population, CT and bronchoscopy are complementary in identifying the source of bleeding, bleeding volume is associated with outcomes and BAE is a key management tool.

Long-term prognostic outcomes in patients with haemoptysis

“…Malignancy, which was reported as the most frequent aetiology in patients with haemoptysis in several studies [ 3 – 6 , 8 , 11 ], represents the only significant predictor of mortality in our study. Haemoptysis related to bronchiectasis, lower respiratory tract infections, and other less frequent aetiologies was not associated with an increase in mortality.…”

Respiratory presentations to acute services at a tertiary hospital in South Africa

“…The recurrent morbidity that can occur with this life-threatening presentation can be forgotten and remains a difficult clinical problem in certain individuals with inoperable disease. [24,25] The burden of lung cancer was high and accounted for 13.3% of all respiratory presentations in our population, but with a discordance in age between the genders, with females being on average 5 years older than men, a significant difference (p=0.03). This finding may reflect local smoking patterns, with females tending to smoke less than their male counterparts.…”

Pulmonary hemorrhage in patients receiving anti-platelets- a case series and a suggested therapeutic algorithm

“…This is the result of the cumulative nature of the inhibitory effects, the slow rate of recovery of platelet thromboxane production (aspirin) or thienopyridine adenosine diphosphate (ADP)-induced platelet aggregation (clopidogrel) and is consistent with the permanent inhibition of cyclooxygenase-1 (COX-1) and the P2Y12 receptor, respectively [ 15 ]. However, when a bleeding event is ongoing the discontinuation of administration of these agents is always the first step, and in cases in which the lung is the principal source of bleeding the algorithm of the management of hemoptysis must be followed thereafter to control bleeding [ 17 ].…”