Advances and challenges in the management of haemoptysis in the emergency department: A narrative review

ABSTRACT

Haemoptysis, defined as the expectoration of blood from the lower respiratory tract, can present to the emergency department (ED) with symptoms ranging from mild, self-limiting to massive haemorrhage. Severe presentations account for approximately 5% of cases, with mortality primarily because airway flooding with blood leading to hypoxia. This underscores the importance of early airway protection and structured resuscitation in emergency settings. This narrative review summarizes the current evidence to guide emergency physicians in the management of haemoptysis. Aetiologies vary geographically: pulmonary tuberculosis accounts for up to 40% of cases in low- and middle-income countries, whereas malignancy, cardiovascular disease, and bronchiectasis predominate in high-income regions. Management begins with differentiating haemoptysis from pseudohaemoptysis and gastrointestinal bleeding, followed by risk stratification and initial stabilization of the patient. CT angiography helps in localization of bleeding and underlying pathology, while flexible bronchoscopy is the gold standard for both diagnosis and therapeutic interventions. Nebulized tranexamic acid is emerging as a rapid, localized, and safe adjunct in emergency settings, reducing the need for invasive procedures. Haemostasis can be achieved by bronchial artery embolization in over 90% of cases, while surgery is reserved for refractory or localized disease. Despite these advances, challenges remain in optimizing the timing and integration of imaging, pharmacological adjuncts, and invasive procedures. A multidisciplinary approach involving emergency physicians, pulmonologists, interventional radiologists, and thoracic surgeons is crucial to improving outcomes in this complex, potentially life-threatening condition. Further studies are needed to standardize protocols and priorities for emergency management of massive haemoptysis.