Hemoptysis is the expectoration of blood or bloody sputum from the lower respiratory tract (below the larynx). While its annual incidence is as low as 0.1% and 0.2% outpatient and inpatient, respectively, it has a high mortality risk if untreated. Although drug-induced hemoptysis is far less common than infectious or chronic inflammatory etiologies, it has been repeatedly documented in case reports and is important to identify and treat to reduce morbidity. Drugs known to cause hemoptysis in some patients include anticoagulants, antiplatelets, NSAIDs, bevacizumab (Avastin), and sildenafil. Abuse of crack cocaine and cocaine laced with levamisole have also been reported to cause hemoptysis.

Although only 1% of the pulmonary blood supply typically comes from bronchial arteries, approximately 90% of hemoptysis cases are bronchial in origin. Patients with chronic inflammation (eg, cystic fibrosis), thrombosis or thromboembolism, vasculitis, lung neoplasms, or any etiology that impairs pulmonary arteries tend to produce more bronchial arteries. Because bronchial arteries are structurally more fragile than pulmonary arteries, they rupture more easily with increased pressure from coughing, resulting in hemoptysis. In many cases, it is patients with these predispositions who are more likely to develop hemoptysis with the initiation of certain drugs, but patients may also develop drug-induced hemoptysis even without any risk factors. Hemoptysis of any etiology is significantly more common in the adult population. The classic patient is around 60 years of age and male.

The treatment for mild hemoptysis is predominantly supportive, involving oxygenation, suction, and occasionally transfusion. In cases of massive hemoptysis, where patients may expectorate ≥ 500 cc of blood in 24 hours or > 100 cc an hour, bronchoscopy may be indicated for invasive treatment.