Management of haemoptysis

If a patient with bronchiectasis has massive haemoptysis, arrange immediate transfer to a hospital with appropriate specialist services. Investigations are generally aimed at localising the site of haemorrhage; they may include computed tomography (CT) scan of the chest with angiography, selective bronchial artery angiography and bronchoscopy. Bronchial artery embolisation or lobectomy may be required.

If a patient with bronchiectasis has recurrent small volume, bright haemoptysis, refer for assessment by a specialist.

Minor haemoptysis (small volume streaky blood mixed with purulent sputum) is common in patients with bronchiectasis. This may be an indication of infection but does not necessarily require further investigation. Assess the patient for signs of bacterial infection—see Assessment of exacerbations of bronchiectasis. Review the use of drugs that may worsen haemorrhage (eg nonsteroidal anti-inflammatory drugs [NSAIDs], anticoagulants).