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Scientists Have Proven That Severe COVID-19 Is A Thrombotic Disease

Severe COVID-19 causes early lung capillary thrombosis, leading to respiratory distress, with studies emphasizing prompt anti-coagulation treatment to mitigate complications.

Scientists from the University of São Paulo have discovered that severe COVID-19 is primarily caused by damage to the small blood vessels in the lungs, a result of SARS-CoV-2 infection.

Blood clot formation (thrombosis) in the small blood vessels of the lungs is an early result of severe COVID-19, often occurring before the breathing difficulties caused by widespread damage to the air sacs, according to a Brazilian study reported in an article published in the Journal of Applied Physiology. Post-mortem examinations of nine individuals who passed away from severe COVID-19 revealed a distinct pattern of changes in lung blood vessel structure and thrombosis.

For the first time, the article describes sub-cellular aspects of the endothelial damage and associated thrombotic phenomena caused by the infection. It notes the impact of acute inflammation on lung microvascular circulation as the key factor in severe COVID-19, contributing to a deeper understanding of the pathophysiology of the disease and the development of novel therapeutic strategies.

"This study furnished the final proof of what we'd been pointing out since the very start of the pandemic – that severe COVID-19 is a thrombotic disease. The virus SARS-CoV-2 has a tropism for [is attracted to] the endothelium, the layer of cells that lines blood vessels. When it invades endothelial cells, it first affects microvascular circulation. The problem starts in the capillaries of the lungs [the tiny blood vessels that surround the alveoli], followed by clotting in the larger vessels that can reach any other organ," said pulmonologist Elnara Negri, first author of the article and a professor at the University of São Paulo's Medical School (FM-USP). She was one of the first researchers in the world to reach the conclusion that severe COVID-19 is a thrombotic disease.

The researchers at USP analyzed lung tissue from nine patients who died from COVID-19. Credit: Elia Caldini

In the study, which was supported by FAPESP, the researchers used transmission and scanning electron microscopy to observe the effects of the virus on lung endothelial cells from severe COVID-19 patients who died at Hospital das Clínicas, the hospital complex operated by FM-USP.

All nine samples obtained by minimally invasive autopsies displayed a high prevalence of thrombotic microangiopathy – microscopic blood clots in small arteries and capillaries that can lead to organ damage and ischemic tissue injury. The samples came from patients who were hospitalized between March and May 2020, required intubation and intensive care, and died owing to refractory hypoxemia and acute respiratory failure.

It is worth noting that none of the patients included in the study was treated with anti-coagulants, as this was not part of the COVID-19 treatment protocol at the time. Nor were any COVID-19 vaccines available in the period.

Endothelial glycocalyx shedding

Negri explained that the endothelium is itself lined by a gel-like layer of glycoproteins called the glycocalyx, which acts as a barrier to regulate the access of macromolecules and blood cells to the endothelial surface. This barrier prevents clotting in blood vessels by inhibiting platelet interaction with the endothelium.

"Previous studies conducted by Helena Nader at UNIFESP [the Federal University of São Paulo] showed that SARS-CoV-2 invades cells mainly by binding to the receptor ACE-2 [a protein on the surface of various cell types, including epithelial and endothelial cells in the respiratory system] but before that, it binds to heparan sulfate [a polysaccharide], a major component of the glycocalyx in endothelial cells. When it invades the endothelium, it triggers shedding and destruction of the glycocalyx, resulting in tissue exposure and intravascular clotting. The process starts in the microcirculation," Negri explained.

Because the virus initially acts on the pulmonary microcirculation, contrast examinations performed during the pandemic to investigate the presence of blood clots in larger vessels in severe COVID-19 patients failed to detect the problem at any early stage, she added. However, endothelial dysfunction is a key phenomenon in COVID-19 since it is directly associated with the activation of the inflammatory response that is characteristic of the disease.

"Massive viral invasion and destruction of the endothelium break down the endothelial barrier and impair the recruitment of circulating immune cells, activating pathways associated with thrombogenesis and inflammation," she said.

In the study, the researchers found that endothelial injury tended to precede two common processes in cases of respiratory distress: significant alveolar-capillary membrane leakage, and intra-alveolar accumulation of fibrin (associated with blood clotting and wound healing).

A study by the same group at FM-USP, led by Thais Mauad and including transcriptomics (analysis of all RNA transcripts, coding, and non-coding), showed that several pathways associated with blood clotting and platelet activation had been activated prior to inflammation in the lungs of patients with alveolar damage.

The analysis also confirmed that the clotting was not typical of the usual process triggered by the activation of coagulation factors. "In COVID-19, the clotting is due to endothelial injury and exacerbated by NETosis [an immune mechanism involving programmed cell death via formation of neutrophil extracellular traps or NETs], dysmorphic red blood cells and platelet activation, all of which makes the blood thicker and causes many complications," Negri said.

When the blood is thick and highly thrombogenic, she added, the patient must be kept hydrated, whereas diffuse alveolar damage in acute respiratory distress syndromes due to other causes requires reduced hydration. "Also, the timing and rigorous control of anti-coagulation are fundamental," she stressed.

Another study by the same group of researchers, including Marisa Dolhnikoff and Elia Caldini, showed lung damage in severe COVID-19 to be associated with the degree of NETosis: the higher the level of NETs in lung tissue obtained by autopsy, the more the lungs were damaged.

Negri said she began to suspect there was a link between COVID-19 and thrombosis early in the pandemic when she noticed a phenomenon recalling her experience some 30 years ago with patients who had microvascular clotting after open-heart surgery with extracorporeal circulation and a bubble oxygenator, no longer used because it causes endothelial damage.

"It was a widely used technique 30 years ago, but it causes lung injury very similar to that seen in COVID-19. So I'd already seen it. Besides the pulmonary injury, another similarity is the occurrence of peripheral thrombotic phenomena, such as red toes, for example," she said.

"As severe COVID-19 sets in, the drop in blood oxygen levels is secondary to pulmonary capillary thrombosis. Initially, there's no buildup of fluid in the lungs, which aren't 'saturated' and don't lose their compliance or elasticity. This means the lungs in early severe COVID-19 patients don't look like sponges full of liquid, as they do in acute respiratory distress syndrome [ARDS] patients. On the contrary, the respiratory failure associated with severe COVID-19 involves dehydration of the lungs. The alveoli fill with air but the oxygen can't enter the bloodstream because of capillary clotting. This leads to what we call 'happy hypoxia', where patients don't experience shortness of breath and aren't aware their oxygen saturation is dangerously low."

While observing the intubation of a severe COVID-19 patient, Negri realized the treatment of such cases should be entirely different from what it was at the start of the pandemic. "The secret to treating severe COVID-19 patients is keeping them hydrated and using anti-coagulant at the right dose, meaning the dose required in the hospital environment at the onset of oxygen desaturation, i.E. Low levels of oxygen in the blood," she said. "After that, the therapeutic dose of anti-coagulant must be calculated daily on the basis of blood work, always in the hospital environment to avoid any risk of bleeding. Prophylaxis is required for an average of four to six weeks after discharge because that's how long the endothelium takes to regenerate."

This hydration and anti-coagulation protocol is needed because, in contrast with other kinds of ARDS in which oxygen in the lungs is prevented from entering the bloodstream mainly by alveolar inflammation, lung capillary endothelial damage is the main obstacle in early severe COVID-19, she explained.

"No one knew about this difference between COVID-19 and other types of ARDS at the very start of the pandemic. Indeed, this is why so many Italian patients died in ICUs [intensive care units], for example. The treatment protocol used then was different," she recalled.

In 2020, before the study was reported in the Journal of Applied Physiology, Negri and her group had already observed that the use of the anti-coagulant heparin improved oxygen saturation in critical patients. In 2021, in collaboration with colleagues in several countries, they conducted a randomized clinical trial in which they succeeded in demonstrating that treatment with heparin reduced severe COVID-19 mortality. The findings were published in the British Medical Journal.

"That study helped bring about a global change in COVID-19 treatment guidelines by showing that COVID-19 mortality risk fell 78% when anti-coagulation was started in patients who needed oxygen supplementation but weren't yet in intensive care," Negri said.

Endothelial dysfunction should be reversed without delay in severe COVID-19, using an anti-coagulant, she explained. "Blood clotting has to be stopped as soon as possible in order to avert the development of acute respiratory distress and other consequences of the disease, such as the problems now known as long COVID," she said.

An article recently published in Nature Medicine by researchers affiliated with institutions in the United Kingdom reinforces the thrombotic nature of the disease, reporting a study in which the only long COVID prognostic markers identified were fibrinogen and D-dimer, proteins associated with coagulation.

"The study shows that long COVID results from inadequately treated thrombosis. The microcirculatory problem can persist in several organs, including the brain, heart, and muscles, as if the patient were having small heart attacks," Negri said.

Reference: "Ultrastructural characterization of alveolar microvascular damage in severe COVID-19 respiratory failure" by Elnara Marcia Negri, Marlene Benchimol, Thais Mauad, Amaro Nunes Duarte-Neto, Maiara Gottardi, Luiz Fernando Ferraz da Silva, Paulo Hilario Nascimento Saldiva, Marisa Dolhnikoff, Wanderley de Souza and Elia Garcia Caldini, 1 October 2023, Journal of Applied Physiology.DOI: 10.1152/japplphysiol.00424.2023

"Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization" by Maxime Taquet, Zuzanna Skorniewska, Adam Hampshire, James D. Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Olivia C. Leavy, Matthew Richardson, Omer Elneima, Hamish J. C. McAuley, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Ruth M. Saunders, Victoria C. Harris, Linzy Houchen-Wolloff, Neil J. Greening, Parisa Mansoori, Ewen M. Harrison, Annemarie B. Docherty, Nazir I. Lone, Jennifer Quint, Naveed Sattar, Christopher E. Brightling, Louise V. Wain, Rachael E. Evans, John R. Geddes, Paul J. Harrison and PHOSP-COVID Study Collaborative Group, 31 August 2023, Nature Medicine.DOI: 10.1038/s41591-023-02525-y

The study was funded by the São Paulo Research Foundation.

From Brain Damage To Heart Disease – The 5 Horrifying Things That Can Happen To Your Body After Vaping

VAPES were once hailed as miracle devices to help adults ditch their smoking habits.

But now vaping has invaded sweet shops shelves, even more worryingly, the school playground.

1

All the ways vaping could damage children's health

The devices often come in fun-sounding flavours, like cotton candy, watermelon ice and cola.

So perhaps it's no surprise vaping has proved popular among teens, and sometimes children even younger.

Figures from the Action on Smoking and Health (ASH) charity suggest 7.6 per cent of 11 to 17-year-olds now vape regularly or occasionally, up from 4.1 per cent in 2020.

In a bid to tackle the rising number of young people taking up vaping, the Government has announced that disposable vapes, like trendy Elfbar and Lost Mary brands, will be banned.

Most experts believe that vaping is nowhere near as harmful as smoking cigarettes.

However, we are now beginning to see the shocking health impact on younger people, with kids as young as nine showing up in hospital with devastating lung damage.

The latest figures from NHS England reveal that in the past year, there were 15 cases of under-nines being hospitalised with injuries ranging from bleeding lungs to lung collapse. 

Here we look at all the ways vaping could be damaging young bodies...

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Young boys who vape risk passing on damaged genes to their future children.

A study from the universities of Southampton and Bergen in Norway found smoking increased the chances of their children developing asthma, obesity and lung problems.

The scientists warned that vaping could also cause similar health conditions.

The findings were "much more pronounced" in children whose fathers started smoking during puberty, compared to those who started smoking at any time before conception.

The evidence came from people whose fathers smoked as teenagers in the 60s and 70s, when smoking tobacco was much more common.

But nicotine found in e-cigarettes could have a similar effect, according to University of Southampton professor John Holloway.

He said: "It's deeply worrying that teenagers today, especially teenage boys, are now being exposed to very high levels of nicotine through vaping.

"We can't definitely be sure vaping will have similar effects across generations but we shouldn't wait a couple of generations to prove what impact teenage vaping might have."

2. Slow down brain development

Vaping nicotine can permanently affect brain development in people under the age of 25, according to the Centers for Disease Control and Prevention (CDC).

It said that nicotine consumed during teenage years can harm the parts of the brain that control attention, learning, mood, and impulse control.

It can also change the way new memories are formed, which can increase the risk of addiction.

Each time a new memory is formed or a new skill is learned, stronger connections – or synapses – are built between brain cells.

Young people's brains build synapses faster than adult brains.

Nicotine is known to influence the way these synapses are formed and can increase the risk of future addiction to other drugs.

3. Tooth decay

People who vape are more likely to experience tooth decay.

Decay is the top reason for hospital admission in under-18s in the UK.

Dr Michael Heffernan, a dentist at The Wessex Dental Specialist Care, which is part of Bupa Dental Care most vapes contain dangerous chemical that can harm your teeth.

But the very act of vaping and sucking in air could in itself lead to tooth decay.

He told the Sun: "When your mouth is dry, the harmful bacteria can grow and overcome your protective bacteria, and increased bacteria levels can lead to the development of tooth decay and gum disease,

"This often appears in the form of increased sticky plaque, which causes inflamed, swollen and bleeding gums, sensitive teeth and bad breath.

"We also know that nicotine (present in e-cigarettes) can restrict blood flow to the gums, and poor circulation can result in more significant gum disease around teeth and potential loss of dental implants.

"However, these effects are less harmful than smoking or chewing tobacco products."

4. Heart disease

Many kids think of vaping as less harmful than smoking cigarettes because there is no smoke.

However, some of the chemicals found in vapes can be damaging to the heart.

The American Heart Association (AHA) released a scientific statement linking vaping among teens and cardiovascular disease.

"The latest research suggests that vaping is as harmful to the body's cardiovascular systems as cigarettes," said Dr Hoang Nguyen a cardiologist from MemorialCare Heart and Vascular Institute is California.

Vaping can also cause:

Arterial stiffness (stiffening of the arterial wall causing hypertension)

Higher blood pressure

Hyperinflammatory response (severe inflammation) which can lead to blood clots and respiratory distress syndrome

Increased heart rate

Released adrenaline

These factors combine to increase the risk of heart attack and stroke, even in otherwise healthy children and teens.

5. Lung disease

Vaping is giving children breathing difficulties and lung damage.

Dr Mike McKean, a paediatric respiratory consultant and vice president of the Royal College of Paediatrics and Child Health said he was seeing a "disturbing" rise in children presenting to hospitals with breathing issues related to vaping.

"It's a very difficult thing to study, firstly, because [vaping] not been going on for too long and it's fair to say we're not seeing large numbers of children with severe lung disease, but it's certainly been reported now where people have developed lung disease related to vaping," he told the BBC.

Jackson Allard, 22, was forced to have double lung transplant last year after his vaping habit left him on a life support machine.

In July, 20-year-old fitness fanatic Sean Tobin from the US, revealed his scan after a collapsed lung due to vaping.

His X-ray was riven with carbon deposits, which showed up as alarming black spots.

Certain chemicals found in vapes are know to cause acute lung injury and chronic obstructive pulmonary disease (COPD) and may cause asthma and lung cancer.

Researchers from the US found young people who vape are more at risk of bronchitis, inflammation of the airways, and shortness of breath.

The study, published in the British Medical Journal, found the odds of wheezing were 81 per cent more likely among past 30-day e-cigarette users than among "never users".

Read more on the Irish Sun

The odds of bronchitic symptoms were twice as likely, while those of shortness of breath were 78 per cent more likely after accounting for survey wave, age, sex, race and parental education.

Anyone who has experienced an adverse effect to should report it to the UK's Medicines & Healthcare products Regulatory Agency (MHRA) via the yellow card reporting scheme.

When will disposable vapes be banned?

The changes are expected to come into force towards the end of this year or in early 2025.

Announcing the move, Rishi Sunak said: "As any parent or teacher knows, one of the most worrying trends at the moment is the rise in vaping among children, and so we must act before it becomes endemic."

Health Secretary Victoria Atkins told BBC Breakfast that ministers "want to help children avoid the horrendous pull of a nicotine habit which for which vapes can very often be the gateway".

She said banning disposable vapes will likely come into force early next year.

Dame Rachel de Souza, the Children's Commissioner for England, said parents would be "extremely relieved" at the proposals.

"When I asked children a couple of years ago about all aspects of their health and wellbeing, I was shocked and concerned to hear from children as young as 12 who told me that vaping was normalised among their peers - even on school premises," she said.

"This announcement will help tackle that issue, and I know that many children and parents will be extremely relieved."

What Does Coughing Up Blood (Hemoptysis) Mean?

Medically reviewed by Renee Nilan, MD

Coughing up blood, medically known as hemoptysis, involves coughing or spitting up blood or blood-streaked mucus from your respiratory tract (i.E. Lungs and airways). Coughed-up blood may appear pink, bright red, or rust-colored, and there may be a small or large amount, depending on the cause.

There are many possible causes for coughing up blood, including acute infections like bronchitis, chronic conditions like cystic fibrosis, a chest or lung injury, pulmonary embolism (blood clot in the lung), or medications like blood thinners. In some cases, coughing up blood can be an early symptom of lung cancer.

Coughing up blood can be an alarming experience, and while it is not often life-threatening, it does warrant a trip to your healthcare provider for diagnosis and treatment.

What Does Coughing Up Blood Look Like?

The appearance of coughed-up blood can vary in color and amount, depending on the source and cause of the bleeding. Here's a breakdown of what blood you cough up may look like.

Color

The color of coughed-up blood can range from pink to bright red to dark red or rust-colored, depending on the source of the bleeding. It is often mixed with air, making the blood appear bubbly or frothy. You may also cough up mucus tinged with blood, which can be mostly clear, yellow, or green in appearance.

Amount

Coughing up blood can occur in small or large amounts. In most cases, the amount of blood coughed up is minimal. You may cough up blood-streaked mucus or large amounts of blood. Coughing up a large amount of bright red blood is an emergency and requires immediate medical attention.

Other Symptoms

You may have additional symptoms along with coughing up blood, depending on what's causing the bleeding. For example, if you have a respiratory infection or pneumonia, you may also have:

If you have a chronic condition causing you to cough up blood, such as cystic fibrosis, you may also experience symptoms associated with your diagnosis.

Types of Hemoptysis

Hemoptysis is categorized based on bleeding severity, meaning the volume of blood loss in 24 hours. This information helps guide the diagnostic process and help with making treatment decisions. Hemoptysis types include:

Mild hemoptysis: A small amount of blood loss, less than 50 milliliters (mL), or about 1.69 fluid ounces, in 24 hours.

Moderate hemoptysis: Moderate blood loss, ranging between 50 to 200 mL in 24 hours.

Massive (severe) hemoptysis: Severe blood loss, more than 200 mL in 24 hours, or 50 mL blood loss in one coughing episode.

Potential Causes

Hemoptysis occurs when there is bleeding in your lower respiratory tract, including the lungs, windpipe, bronchi, bronchioles, and alveoli. Sometimes, you may cough up blood from other sources, like your mouth or nose, known as pseudohemoptysis.

Many things can cause coughing up blood, ranging from minor to serious.

Respiratory Infections

Upper and lower respiratory infections, such as pneumonia, bronchitis, and tuberculosis, are among the most common causes of hemoptysis. Bacteria, viral, or fungal infections can inflame and irritate the airways and lungs, leading to a cough with mucus streaked with small amounts of blood. If you have a violent cough due to a respiratory infection, you may notice blood-streaked mucus when you cough.

People of all ages can develop respiratory infections, but certain groups are at a higher risk, including older adults, children, and people with chronic lung conditions (e.G., chronic obstructive pulmonary disease, asthma).

Lung Cancer

Up to 20% of people with lung cancer experience hemoptysis, and for many people who develop lung cancer, coughing up blood is the first sign. Bleeding can occur when a tumor irritates or grows into blood vessels in the lungs or surrounding tissues or when a chronic cough irritates the tissues of the respiratory tract. Although coughing up blood involves minor blood loss in most people with lung cancer, about 3% of all cases involve massive, life-threatening hemoptysis.

In addition to coughing up blood, other symptoms of lung cancer include a chronic cough, fatigue, unexplained weight loss, wheezing, and shortness of breath. Primary risk factors for lung cancer include smoking, long-term exposure to secondhand smoke or other irritants (e.G., air pollution, chemical dust), and a family history of lung cancer.

Pulmonary Embolism

A pulmonary embolism (PE), which is the medical term for a blood clot in the lungs, can cause hemoptysis. A PE occurs when a blood clot that develops in another part of the body, such as the leg, breaks free and travels through the bloodstream, where it becomes lodged in a pulmonary artery (in the lungs).

Symptoms of PE include coughing up blood, shortness of breath, chest pain, lightheadedness, and excessive sweating. Risk factors for developing a PE include smoking, having obesity, having an underlying lung or heart condition, and prolonged inactivity (e.G., bedrest, long-distance travel).

Bronchiectasis

Bronchiectasis is a chronic lung disease that develops when the bronchi (airways) are damaged and permanently widen. It is a progressive condition that causes scarring and thickening of the bronchial walls, leading to mucus build-up in the airways and frequent respiratory infections.

With bronchiectasis, inflamed and irritated airways can lead to coughing up blood-tinged mucus or coughing blood. Other symptoms include chest pain, shortness of breath, and fatigue. Certain conditions can increase the risk of bronchiectasis, including cystic fibrosis, autoimmune diseases, immunodeficiency-related disorders (e.G., HIV/AIDS), and chronic obstructive pulmonary disease (COPD).

Other Causes

Though less common, other conditions and factors can cause coughing up blood, including:

Cystic fibrosis

Anticoagulants (blood thinning medications), such as heparin or warfarin

Heart failure

Vascular (blood vessel) disorders, such as vasculitis

Drug use (e.G., cocaine)

Trauma or injury to the lungs or airways

Ingestion of a foreign (non-food) object

Lung abscess (pus-filled cavity in the lung)

Pulmonary edema (fluid build-up in the lungs)

Bleeding disorders, such as hemophilia

Autoimmune disorders, such as systemic lupus erythematosus (often known simply as lupus)

When to See a Healthcare Provider

Coughing up blood can be an unsettling experience. While it isn't usually life-threatening, it does require medical attention to determine the cause, as sometimes it is a sign of an underlying problem that requires diagnosis and treatment.

See your healthcare provider promptly if you are coughing up blood or blood-tinged mucus and have a diagnosis or symptoms of an underlying condition associated with hemoptysis.

Significant blood loss is a medical emergency and potentially life-threatening. Call 911 or visit the nearest emergency room if you experience any of the following symptoms:

Coughing up more than a few teaspoons of blood

Bloody urine or stool

Chest pain

Dizziness or lightheadedness

Fever

Severe shortness of breath

Weakness or unusual, unexplained fatigue

Unusual sweating

Rapid heart rate

Diagnosis

When you visit your healthcare provider, they will ask about your symptoms, review your medical history, and perform a physical examination. During your visit, they may ask:

When your cough started and when you first noticed blood in your mucus

Whether anything triggers coughing or the appearance of blood (e.G., lying down, cold temperatures, physical activity)

How much blood you cough up at a time/per day

Whether you have other symptoms (e.G., fever, chest pain, weight loss) 

During the physical examination, your healthcare provider will listen to your breathing and heart rate with a stethoscope and closely examine your neck and legs to look for signs of bulging blood vessels or swelling (edema). They will also examine your mouth and nose for signs of injury or bleeding. They may ask you to cough to see if any blood comes up.

Based on the findings from the physical examination, your healthcare provider may order diagnostic tests to determine what's causing the bleeding. These tests may include:

Blood tests to measure your blood oxygen levels and complete blood count (CBC)

Imaging tests, such as a chest X-ray or computed tomography (CT) scan, to look for abnormalities in the lungs and airways (e.G., infection, injury, tumor)

Bronchoscopy, which involves inserting a flexible tube (bronchoscope) through your mouth and down your throat to look at your airways

Pulmonary arteriography, a test that uses a special dye and X-rays to visualize how blood flows through your lungs

How to Stop Coughing Up Blood

With mild to moderate blood loss from coughing, treating the underlying cause may be enough to stop the bleeding or prevent significant blood loss. In severe cases with substantial blood loss, treatments can be used to keep your airways open and stop the bleeding. This may involve:

Intubation: This involves placing a tube in your nose or mouth and down your throat to keep your airways open.

Bronchoscopy: A bronchoscope (flexible tube) allows your healthcare provider to view the airways and remove clots that may be causing bleeding.

Bronchial artery angiography and embolization: If a major blood vessel is the source of bleeding, this procedure can close off and stop blood flow in the affected blood vessel.

Medication: Antifibrinolytic medicines, such as tranexamic acid, help stop bleeding and prevent further blood loss.

Surgery: In cases where other measures (e.G., bronchoscopy, medications) do not stop the bleeding, emergency surgery may be necessary.

If a heavy, violent cough is the cause of coughing up blood, here are things you can do at home that may help soothe your airways. These include:

Cough suppressants: Over-the-counter cough medicines may help suppress a heavy cough. These medicines are not safe for everyone, so check with your healthcare provider before using them.

Drink water: Staying hydrated can help keep mucus thin, making it easier to cough it up without irritating your airways.

Avoid smoking and other irritants: Smoking and other environmental irritants, such as dust, powders, and chemicals, can worsen a cough.

Related: How Much Water Should You Drink Each Day?

Complications and Prognosis

In cases of massive hemoptysis that cause heavy bleeding and significant blood loss, possible complications include:

Respiratory distress or failure: Severe, large-volume blood loss can obstruct the airways, leading to difficulty breathing, and may require oxygen therapy or mechanical ventilation to help you breathe and prevent death.

Aspiration pneumonia: Inhaling blood into the lungs can trigger this type of pneumonia,

Anemia: Significant blood loss, especially prolonged or recurrent blood loss, can lead to anemia, causing fatigue, weakness, and shortness of breath.

Hypovolemic shock: In rare cases, massive hemoptysis can lead to life-threatening blood loss and shock, which is life-threatening without treatment. 

In non-emergency cases, the prognosis for people experiencing hemoptysis depends on the cause of coughing up blood and the severity of the condition. Generally, early diagnosis and treatment for the underlying condition can help improve long-term outcomes.

A Quick Review

Coughing up blood, though alarming, isn't always a sign of a serious problem, but it does warrant medical attention. Possible causes of coughing up blood range from acute respiratory infections to chronic conditions, such as lung or heart disease. While minor blood loss does not require immediate treatment, significant blood loss can be life-threatening and requires emergency care.

See a healthcare provider if you're coughing up blood, even small amounts. Early diagnosis and treatment are key to managing the underlying cause and preventing complications. Your provider can determine the cause and recommend the most effective treatment. 

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