Management -
In all cases acknowledge and explore the patient’s and family’s ideas and expectations. Deal with fears honestly.
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Radiotherapy, both external beam and endo-bronchial are effective in reducing the frequency and severity of haemoptysis. External beam radiotherapy has a response rate of 80% for haemoptysis associated with lung cancer, but can only be given to the tolerance of the lung tissue
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Laser treatment is available in a limited number of centres and is highly effective and can be repeated indefinitely.
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Anti-fibrinolytics such as tranexamic acid 1g tds may help some patients and should be considered when the patient is unfit for other interventions.
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Oral steroids can help when the haemoptysis is due to tumour progression. Start dexamethasone 8mg as a single morning dose and titrate downwards after one week to the minimum dose that controls symptoms. If no effect after one week stop. Use appropriate GI protection using either a proton pump inhibitor or misoprostol in at risk patients.
Catastrophic haemoptysis
In approximately 1% of all haemoptyses the bleed will be the terminal event. In such cases there has usually been a number of smaller ‘herald’ bleeds.
Managing such cases is difficult and traumatic for all involved. If there is concern about a large haemoptysis, decisions about place of care need to be made with the patient and family. The family need to know what they can do and who to contact.
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