Coughing up blood (hemoptysis) in ABPA (Allergic Bronchopulmonary Aspergillosis) patients can be a distressing symptom and may indicate underlying inflammation, airway damage, or complications. Here’s how to help and manage this symptom:


Immediate Steps

1. Stay Calm and Assess Severity

  • Small Amounts of Blood (streaks or specks):
    This is often due to irritation or minor damage in the airways and might not be immediately dangerous. However, it should still be reported to a doctor.
  • Larger Amounts of Blood (more than a tablespoon or continuous bleeding):
    This could indicate more serious damage or infection and requires urgent medical attention.

2. Encourage Rest

  • Avoid strenuous activity, which could exacerbate bleeding.

3. Positioning

  • Sit upright to improve breathing and reduce the risk of blood pooling in the lungs.

4. Monitor Symptoms

  • Track the frequency, volume, and color of the blood in sputum, and note any associated symptoms (e.g., shortness of breath, chest pain).

When to Seek Immediate Medical Help

  • Significant blood loss (more than a tablespoon).
  • Sudden worsening of symptoms like severe shortness of breath or chest pain.
  • Signs of shock (e.g., pale skin, rapid heartbeat, dizziness).

Call 999 or go to A&E in such cases.


Long-Term Management

1. Medical Evaluation

  • Consult a Pulmonologist/Respiratory consultant:
    A specialist can assess the cause of bleeding and recommend targeted treatments.
  • Diagnostic Tests:
    Tests like a chest CT scan, bronchoscopy, or sputum culture can identify the extent of lung damage or infection.

2. Medications

  • Corticosteroids:
    To reduce airway inflammation and prevent further damage.
  • Antifungal Therapy:
    If the fungal load contributes to airway irritation or infection.
  • Bronchodilators:
    To help keep airways open and ease breathing.
  • Haemostatic Agents:
    In severe cases, medications that help control bleeding may be prescribed eg. tranexamic acid.

3. Procedures

  • Bronchial Artery Embolization (BAE):
    In cases of recurrent or severe hemoptysis, this procedure can seal off the bleeding blood vessels in the lungs.
  • Surgery:
    Rarely, surgery may be needed to remove a damaged part of the lung if other treatments fail.

4. Lifestyle and Environmental Adjustments

  • Avoid Triggers:
    Minimize exposure to mould, dust, and allergens that can worsen ABPA.
  • Quit Smoking:
    Smoking aggravates lung damage and must be avoided.
  • Humidified Air:
    Using a humidifier can reduce airway irritation.

5. Psychological Support

  • Address Anxiety:
    Hemoptysis can be frightening. Offering reassurance and encouraging open discussions with healthcare providers can help alleviate fears.
  • Peer Support Groups:
    Connecting with others who manage ABPA can provide emotional relief and practical tips.

Preventive Measures

  • Adhere to ABPA treatment plans to reduce inflammation and fungal burden.
  • Maintain regular check-ups to monitor lung health.
  • Stay vigilant about early signs of flare-ups and seek timely care.