Observational, multicentre study on the epidemiology of haemoptysis

Abstract

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...

Managing Massive Hemoptysis

“…chestjournal.org comparison with bronchoscopy (48.7% of cases). 14 The combination of both CT scan and bronchoscopy was diagnostic of the etiology of hemorrhage in 83.9% of cases. However, the study population was of a combination of both minor and massive hemoptysis, thereby underestimating the true diagnostic ability for bronchoscopy to lateralize the side of culprit bleeding in cases of massive hemoptysis.…”

“…11 TB, bronchiectasis, mycetoma, and cancer are the leading etiologies of massive hemoptysis. 11,14 Among regions of the world with a high endemic burden of TB, it is the dominant cause of hemoptysis and remains the most common cause of massive hemoptysis worldwide. 15 Iatrogenic hemoptysis occurring from procedures is reported in 0.26% to 5% of diagnostic bronchoscopies; however, massive hemoptysis complicates only a minute fraction of these procedures.…”

Haemoptysis and fever in a young refugee from Somalia

“…Active TB is an uncommon cause of haemoptysis in Italy, but represents an important bleeding aetiology in high TB incidence countries (Mondoni et al, 2018). Patients with haemoptysis from these areas should be screened promptly for the disease and a bronchoscopy should be considered to exclude endobronchial tuberculosis (EBTB) (Mondoni et al, 2017).…”

Localized Bronchial Hyperemia in Cases of Iatrogenic Hemoptysis: Clinical Presentations and Pathophysiological Mechanisms

“…Bronchoscopy and CT scan are complementary techniques in both diagnosis and bleeding source localization. CT scan is more accurate for parenchymal and vascular abnormalities (such that described in the Case 3), while bronchoscopy is more sensitive to detect endobronchial lesions [2,8].…”

“…Etiology is extremely diverse, malignancies, bronchiectasis, post-tuberculosis sequelae, and idiopathic bleedings being the most frequent causes worldwide. Iatrogenic hemoptysis (such as these following angiographic interventions) is an uncommon cause of this symptom [1][2][3]. The underlying pathophysiology can be complicated, thus physicians treating such cases should have thorough knowledge of the airway's normal vasculature and potential abnormalities.…”