Presentation of haemoptysis in palliative care

Lordan, 2003Panda, 2017Radchenko, 2017

Haemoptysis is the expectoration of blood from the lower respiratory tract; it is sometimes difficult to differentiate from bleeding from the upper airway or oesophagus.

Most episodes of haemoptysis originate from the pulmonary artery circulation, which is under low pressure, resulting in self-limiting, small-volume bleeds. The most common causes of small-volume haemoptysis in patients with palliative care needs are bronchitis, bronchiectasis and lung cancer.

Haemoptysis is considered massive or life threatening when the expectoration of blood is approximately 150 mL (half a cup) over 24 hours, or at a rate higher than 100 mL per hour. This volume of blood can cause airway obstruction, decreased gas exchange and haemodynamic compromise. The source of bleeding is the higher pressure bronchial artery circulation. The most common causes of life-threatening haemoptysis in palliative care are bronchiectasis, tuberculosis, lung cancer, pulmonary aspergillosis, and antivascular endothelial growth factor drugs (eg bevacizumab).

Although massive haemoptysis is relatively rare, consider the risk of massive haemoptysis in patients with palliative care needs and plan for management in advance—see Planning for management of bleeding in palliative care.