Management of patients presenting with haemoptysis to a Tertiary Care Italian Emergency Department: the Florence Haemoptysis Score (FLHASc)

Vanni, Simone; Bianchi, S.; Bigiarini, Sofia; Casula, Claudia; Brogi, Marco; Orsi, Stefano; Acquafresca, Manlio; Corbetta, Lorenzo; Grifoni, Stefano

doi:10.1007/s11739-017-1618-8

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…For centuries, haemoptysis has been considered pathognomonic for pulmonary tuberculosis [2,3]. In our cohort, active tuberculosis accounted only for 3.3% of all cases, confirming the low incidence recorded in Europe (0.3-10.0%) over the past decade [3][4][5][6][7]. In geographical areas with a higher TB incidence, TB remains a relevant cause of haemoptysis (15.0-24.8%) (e.g.…”

supporting

confidence: 83%

“…Although malignancies were less frequent than other aetiologies, their percentage (13%-17.8%) was only slightly lower than that found in our cohort [3][4][5]. Bronchiectasis and respiratory infections such as pneumonia and acute bronchitis are frequent aetiologies in the latest European studies [3][4][5][6][7]. Bronchiectasis was also the main bleeding cause in recent epidemiological investigations performed in South Korea and Iran [11,12].…”

contrasting

confidence: 67%

“…Notably, a recent study performed in an Italian emergency department showed similar frequencies for three aetiologies (i.e. malignancy, pneumonia and bronchiectasis) [6]. Moreover, malignancy was the most important case of haemoptysis in a recent study carried out in Turkey [10].…”

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confidence: 90%

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Observational, multicentre study on the epidemiology of haemoptysis

et al. 2018

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Haemoptysis, which is a challenging symptom accounting for 10-15% of all pulmonology consultations, may be associated with life-threatening medical conditions such as lung cancer [1-7]. Its aetiology and epidemiology vary widely among studies according to geographic locations and time of publication, epidemiological design, and diagnostic tests employed [2-8]. Bronchiectasis, malignancies, post-tuberculosis sequelae, and idiopathic bleedings have been recognised as the most frequent causes of haemoptysis in Europe over the last decade [3-7]. No guidelines exist suggesting an optimal work-up of symptoms, and data on the diagnostic yield of the most commonly prescribed examinations are limited [8]. The aim of this observational, prospective, multicentre study was to investigate the haemoptysis aetiology in association with its severity in an Italian population. We also evaluated the diagnostic yield of the prescribed diagnostic tests. The study was approved by the ethical committees of five Italian participating hospitals and registered at ClinicalTrials.gov (identifier: NCT02045394). Written informed consent was signed by the recruited patients, who were followed-up for 18 months. Herein, we report the findings of the baseline assessment. From July 2013 to September 2015, consecutive adult (i.e. ⩾18 years old) patients with haemoptysis were considered eligible. The following were considered as exclusion criteria: 1) aetiology of haemoptysis already detected (e.g. proven cancer-related and/or bronchiectasis-related haemoptysis); and 2) refusal to sign the informed consent. Patients were divided into three groups on the basis of the total amount of blood expectorated in 24 h [2, 3, 9]: mild (i.e. drops of blood to 20 mL in 24 h), moderate (i.e. 20-500 mL in 24 h), and severe (i.e. >500 mL in 24 h). All enrolled patients underwent physical examination and blood analysis. Subsequent tests deemed necessary for the diagnosis (i.e. sputum cultures, chest radiography, multi-detector chest computed tomography (CT), bronchoscopy, otorhinolaryngological evaluation, angiography) were chosen by the attending clinician on the basis of the clinical hypothesis and the symptom-driven diagnostic protocols of each hospital involved in the study. Final diagnosis was established in each centre, on the basis of the clinical and imaging evidence, by a multidisciplinary consensus that involved pulmonologists, radiologists, pathologists and otorhinolaryngologists. An electronic ad hoc form was created to collect demographic, epidemiological and clinical variables. Absolute and relative frequencies were used to summarise qualitative variables. Quantitative variables, for which the non-parametric distribution was assessed with the Shapiro-Wilk test, were summarised with medians and interquartile ranges (IQRs). 95% confidence intervals were computed to provide an interval estimation. The statistical software used for all the computations was Stata13.0 (StataCorp, College Station, TX, USA). During the study period, 606 patients (median age 67...

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confidence: 83%

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confidence: 67%

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Observational, multicentre study on the epidemiology of haemoptysis

et al. 2018

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“…Hemoptysis is a challenging symptom which can be associated with potentially life-threatening medical conditions 1,2 . Recent studies showed that lung cancer, bronchiectasis, and lower respiratory tract infections are the most frequent etiologies [2][3][4][5][6][7][8] . However, despite an accurate initial work-up, a subgroup of patients with hemoptysis does not have an etiological diagnosis (i.e., idiopathic or cryptogenic hemoptysis) [2][3][4][5][6][7][8][9] ; furthermore, diagnostic changes from the baseline assessment to recurrences were recently described 2,9 .…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies showed that lung cancer, bronchiectasis, and lower respiratory tract infections are the most frequent etiologies [2][3][4][5][6][7][8] . However, despite an accurate initial work-up, a subgroup of patients with hemoptysis does not have an etiological diagnosis (i.e., idiopathic or cryptogenic hemoptysis) [2][3][4][5][6][7][8][9] ; furthermore, diagnostic changes from the baseline assessment to recurrences were recently described 2,9 . In particular, lung cancer was found in patients with idiopathic hemoptysis or lower respiratory infections and a diagnosis of bronchiectasis was performed in a non-negligible proportion of patients initially diagnosed with cryptogenic bleeding 2,10 .…”

Section: Introductionmentioning

confidence: 99%

Long-term Prognostic Outcomes in Patients With Hemoptysis

Mondoni

Carlucci

Cipolla³

et al. 2021

Preprint

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Background: Hemoptysis is a challenging symptom which can be associated with potentially life-threatening medical conditions. Follow-up is key in these patients to early detect new or misdiagnosed pathologic findings. Few prospective studies evaluated long-term prognostic outcomes. Furthermore, the role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear.The aim of the study was to assess the mortality after 18 months of follow-up; furthermore, it was evaluated the incidence of recurrences and the factors associated with both recurrence and death (including the role played by anticoagulant and antiplatelet drugs).Methods: Observational, prospective, multicentre, Italian study.Results: 451/606 (74.4%) recruited patients with hemoptysis completed the 18 months follow-up.22/604 (3.6%) diagnoses changed from baseline to the end of the follow-up. 83/604 (13.7%) patients died. In 52/83 (62.7%) patients, death was the outcome of the disease which caused hemoptysis at baseline. Only the diagnosis of lung neoplasm was associated with death (OR (95%CI): 38.2 (4.2-347.5); p-value: 0.0001).166 recurrences were recorded in 103/604 (17%) patients. The diagnosis of bronchiectasis was significantly associated with the occurrence of a recurrence (OR (95% CI): 2.6 (1.5-4.3)); p-value <0.0001).Anticoagulant, antiaggregant, and anticoagulant plus antiaggregant drugs were not associated with an increased risk of death and recurrence.Conclusions: Our study showed a low mortality rate in patients with hemoptysis followed-up for 18 months. Pulmonary malignancy is the main etiology and the main predictor of death, whereas bronchiectasis is the most frequent diagnosis associated with recurrence. Antiplatelet and/or anticoagulant therapy do not change the risk of death or recurrence. Follow-up is recommended in patients initially diagnosed with lower airways infections and idiopathic bleedings.Clinical trial registration: NCT02045394.

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Approach to Hemoptysis in the Modern Era

Gagnon

Quigley

Dutau

et al. 2017

Canadian Respiratory Journal

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Hemoptysis is a frequent manifestation of a wide variety of diseases, with mild to life-threatening presentations. The diagnostic workup and the management of severe hemoptysis are often challenging. Advances in endoscopic techniques have led to different new therapeutic approaches. Cold saline, vasoconstrictive and antifibrinolytic agents, oxidized regenerated cellulose, biocompatible glue, laser photocoagulation, argon plasma coagulation, and endobronchial stents and valves are amongst the tools available to the bronchoscopist. In this article, we review the evidence regarding the definition, etiology, diagnostic modalities, and treatment of severe hemoptysis in the modern era with emphasis on bronchoscopic techniques.

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Management of patients presenting with haemoptysis to a Tertiary Care Italian Emergency Department: the Florence Haemoptysis Score (FLHASc)

Cited by 7 publications

References 20 publications

Observational, multicentre study on the epidemiology of haemoptysis

Observational, multicentre study on the epidemiology of haemoptysis

Long-term Prognostic Outcomes in Patients With Hemoptysis

Approach to Hemoptysis in the Modern Era

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