Ask a doctor on the topic of Internal medicine

Blood in sputum

October 12, 2012 | 50,00 EUR | answered by Dr. med. Kathrin Hamann

I am a 53-year-old female smoker who smokes 10-15 cigarettes a day. Three weeks ago, after doing breathing exercises, I noticed phlegm in my chest (rattling). Since I did not have a cough, I intentionally coughed and after coughing several times, I noticed a bit of blood mixed with the phlegm. I immediately went to my general practitioner, who recommended waiting about 14 days, as I am a patient taking aspirin. The aspirin was stopped immediately. After 12 days, following a sauna session, I noticed more phlegm (rattling) again. This time, I waited until the phlegm was easier to cough up, and once again, there was a tiny thread of blood in the phlegm.

I then went to a pulmonologist, who conducted a chest X-ray in two dimensions, which showed no abnormalities. He compared the X-ray images with previous ones and found no issues. To be safe, I also had a throat and trachea examination by an ENT specialist, who found a small vascular situation at the base of my right tongue. The ENT specialist suggested that the bleeding may have been caused by constant clearing of the throat and coughing up phlegm. In the final consultation with the pulmonologist, I was told not to worry, to stop monitoring the sputum, and to only consider a bronchoscopy if I experience difficulty breathing.

Yesterday, after another sauna session, I noticed more blood in the phlegm, this time in slightly larger amounts and more like droplets. However, I am also currently experiencing a cold and nasal congestion. Could it be that I am irritating my bronchial tubes myself, causing the blood to appear? I must admit that I am under a lot of psychological stress, as I have been reading constantly about lung cancer online, which is what triggered all of this. Should I take any further action, or should I simply trust the pulmonologist that it will go away on its own?

Dr. med. Kathrin Hamann

Hello,

I would trust the pulmonologist here.
The sauna (heat) expands the blood vessels, making it easier to start bleeding if the bronchi are irritated by coughing.
It is urgent that you reduce or quit smoking, as smoking causes the bronchi to produce additional mucus for cleansing. The heat in the sauna slightly liquefies the mucus, causing irritation and coughing. The dilated blood vessels of the mucous membrane can bleed more easily when coughing.

With a thorough examination (ENT examination and chest X-ray in 2 planes) without any abnormal findings, you do not need to worry.

As mentioned, it is essential to reduce smoking, or better yet, quit altogether. Have your lung function checked regularly (every 1-2 years) and prescribe medication if abnormalities are found, as smokers are often at risk of developing COPD (chronic lung disease).

Do you have any questions about this? I am happy to help.

All the best and a speedy recovery.

Best regards,
Dr. K. Hamann