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Small and moderatly abundant hemoptysis

They generally do not necessitate specific emergency measures. Bronchofibroscopy may permit finding the origin of hemoptysis and potentially propose a specific treatment (even in palliative non terminal phase).

For instance, local treatment by pulmonary artery embolisation or by laser or by endobronchial brachytherapy or by external radiotherapy and if necessary and feasible a simple surgical intervention.

Massive hemoptysis

Massive bronchial haemorrhage (hemoptysis) is rarely involved in patient death in lung cancer. The flooding of the bronchial tubes is far more life-threatening than the actual quantity of blood lost.

The most frequently concerned cancer is epidermoid lung cancer since it invades blood vessels and is highly necrotic.

Another frequent cause of hemoptysis is pulmonary aspergillosis which often occurs in immunodeprived patients (after prolonged chemotherapy).

More rarely, hemoptysis is related to therapy (laser, endobronchial brachytherapy).

Treatment includes very simple measures such as adopting a semi-seated position, oxygenation, aspiration, and a rapid search for the aetiology (bronchosopy if the patient’s status permits).

In terminal hemoptysis, patient anxiety should be relieved (subcutaneous morphine, midazolam), and a carer/family member should remain at the patient’s bedside until sleeping.

If no efficient aetiological treatment is possible (surgery for instance), various techniques have been proposed such as a Fogarty catheter, arterial embolisation, radiotherapy or laser beam.