Evaluation and management of hemoptysis

ABSTRACT: Hemoptysis, defined as the expectoration of blood originating from the lower respiratory tract, is a clinical symptom with a wide differential diagnosis that ranges from benign to life-threatening causes. Common causes vary by geographic region and care setting, with respiratory infections, malignancy, bronchiectasis, and chronic obstructive pulmonary disease being predominant in resource-rich countries and tuberculosis remaining the leading cause in resource-limited areas. Though most cases are mild and self-limited, hemoptysis can be a life-threatening medical emergency; these cases are associated with a mortality exceeding 50%, primarily due to asphyxia. Management strategies are informed by severity, with outpatient care appropriate for stable patients with non-life-threatening hemoptysis and intensive interventions-such as bronchial artery embolization or surgical resection-reserved for those with high-risk features or life-threatening hemoptysis. This article provides an evidence-based approach to hemoptysis evaluation and management, emphasizing the importance of early risk stratification, identification of underlying causes, and timely intervention. By integrating a structured diagnostic and therapeutic approach, clinicians can improve outcomes and reduce the risk of recurrence and complications.