What management strategies should be considered for a patient with recurrent haemoptysis?

Management strategies for a patient presenting with recurrent haemoptysis should begin with a thorough clinical assessment to determine the severity and underlying cause of bleeding, as recurrent haemoptysis may indicate serious pathology such as pulmonary arterial hypertension, infection, malignancy, or bronchiectasis (Baroutidou et al., 2022).

Initial management includes stabilisation of the airway, breathing, and circulation, with attention to haemodynamic status and oxygenation. In cases of massive or ongoing bleeding, urgent resuscitation with blood products may be necessary, guided by clinical judgement and local protocols ¹.

Diagnostic evaluation should include imaging such as chest X-ray and computed tomography (CT) to localise the bleeding source and identify underlying pathology. Bronchoscopy is often indicated for direct visualisation and potential therapeutic intervention (Baroutidou et al., 2022).

For patients with recurrent haemoptysis related to pulmonary arterial hypertension or congenital heart disease, management may require multidisciplinary input including cardiology and respiratory specialists, with consideration of targeted therapies to control pulmonary pressures and reduce bleeding risk (Baroutidou et al., 2022).

Endoscopic interventions, such as bronchial artery embolisation, are effective in controlling bleeding and preventing recurrence, especially when bleeding is localized and refractory to conservative measures (Baroutidou et al., 2022). Surgical options may be considered if embolisation fails or if there is a rebleed with life-threatening haemoptysis ¹.

In patients with underlying chronic lung disease such as COPD, optimisation of respiratory status including smoking cessation, pulmonary rehabilitation, and treatment of infections is essential to reduce exacerbations and haemoptysis risk ².

Anticoagulation and antiplatelet therapy should be carefully reviewed and managed, balancing bleeding risk and thrombotic indications, with reversal agents used if active bleeding occurs ¹.

Overall, management of recurrent haemoptysis requires a tailored approach based on the cause, severity, and patient comorbidities, integrating stabilisation, diagnostic evaluation, targeted medical and interventional therapies, and multidisciplinary care (Baroutidou et al., 2022; ¹,²).