Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Life-threatening haemoptysis
Rapid pulmonary bleeding threatens death through airway flooding and asphyxia as well as blood loss; the witnessed volume may underestimate danger.
Action: Call emergency help within the agreed ceiling, stay with the patient, position the bleeding lung down when known, use dark towels and clear visible blood from the mouth without deep blind suction. Give prepared rapid-route anxiolytic only if immediately available and time permits; presence and calm communication must not be delayed by searching for medicines.
Synopsis
Assess cough and haemoptysis by mechanism and bleeding risk, treat reversible causes, use proportionate antitussive and tumour-directed therapy, and prepare a simple presence-led plan for foreseeable catastrophic pulmonary haemorrhage.
Ask whether blood truly came from the lower respiratory tract, then assess airway, breathing, circulation and trajectory rather than relying on volume alone.
First-line cough assessment defines dry or productive, triggers, timing, aspiration, reflux, medicines, infection, obstruction and impact on sleep, speech and eating.
Treat the cause when useful: antibiotic, bronchodilator, reflux care, drainage, airway clearance, bronchoscopy, embolisation, radiotherapy or anticoagulant review may outperform cough suppression.
Key red flags
Any haemoptysis with airway compromise, hypoxaemia, haemodynamic instability or rapidly accumulating blood is an emergency regardless of measured volume.
Airway-threatening haemorrhage
Rapid blood flow, inability to clear clot, falling oxygenation or respiratory distress defines a life-threatening event regardless of volume.
Investigation priorities
01
First-line source and stability assessmentFirst stepFirst line
Confirm likely respiratory blood, quantify rate and recurrence and assess airway, ventilation, oxygenation, circulation and known bleeding risk.
Management branches
Cough managementTreat mechanism before suppressing reflex
Cough is distressing, persistent or interfering with sleep, speech, eating or treatment.
Characterise dry or productive pattern, aspiration, reflux, medicines, airway and infection and identify red flags or protective clearance need.
Treat the cause and use position, hydration, airflow, swallow and physiotherapy measures before selecting a low-dose antitussive for a dry refractory cough.
Key medicines
Immediate-release morphine for refractory dry coughIn an opioid-naive adult, a specialist palliative protocol may use 2.5 mg oral immediate-release morphine as needed or at a defined interval and titrate cautiously; calculate from current exposure when already opioid treated and use a renal-appropriate alternative when needed.
Codeine for selected dry coughA typical adult antitussive dose is 15 to 30 mg orally every 4 to 6 hours as required under the BNF, with the lowest effective exposure and a short response review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.