http://dx.doi.org/10.4046/trd.2012.73.2.

107
ISSN: 1738-3536(Print)/2005-6184(Online)
Tuberc Respir Dis 2012;73:107-114
Copyright2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Original Article

Analysis of Patients with Hemoptysis in a Tertiary Referral Hospital

Bo Ram Lee, M.D., Jin Yeong Yu, M.D., Hee Jung Ban, M.D., In Jae Oh, M.D., Kyu Sik Kim, M.D., Yong
Soo Kwon, M.D., Yu Il Kim, M.D., Young Chul Kim, M.D., Sung Chul Lim, M.D.
Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju,
Korea

Background: This study attempted to investigate the main causes of hemoptysis, the type of examinations used
for diagnosis, the treatment modalities and outcomes.
Methods: A retrospective study was conducted on the medical records of 221 patients admitted to the Chonnam
National University Hospital, between January 2005 and February 2010, with hemoptysis.
Results: Bronchiectasis (32.6%), active pulmonary tuberculosis (18.5%), fungus ball (10.8%), and lung cancer (5.9%)
accounted for most causes of hemoptysis. Computed tomography scan was the most sensitive diagnostic test when
employed alone, with positive yield of 93.2%. There were 161 cases of conservative treatment (72.9%), 42 cases
of bronchial artery embolization (BAE) (19.0%), and 18 cases of surgery (8.1%). Regarding the amount of
hemoptysis, 70 cases, out of 221 cases, were mild (31.5%), 36 cases moderate (16.2%), and 115 cases massive
hemoptysis (52.0%). Most of the patients were treated conservatively, but if there was more bleeding present,
BAE or surgery was more commonly performed than the conservative treatment (p0.0001). In the multivariate
model, severe hemoptysis and lung cancer were independently associated with short-term recurrence. BAE was
independently associated with long-term recurrence, and lung cancer was associated with in-hospital mortality.
The overall in-hospital mortality rate was 11.3%.
Conclusion: Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting
massive bleeding or those with malignancy had a poorer prognosis. In-hospital mortality was strongly related to
the cause, especially in lung cancer.
Key Words: Hemoptysis; Etiology; Diagnosis; Therapeutics; Treatment Outcome

Introduction
Hemoptysis is the expectoration of blood from the
airways. Hemoptysis results from destroyed lung parenchyma, for which the most common causes are tuber1,2
culosis and bronchiectasis in Korea , and bronchitis
and bronchial cancer in other countries3,4.

Address for correspondence: Sung Chul Lim, M.D.

Department of Internal Medicine, Chonnam National
University Hospital, 42, Jebong-ro, Dong-gu, Gwangju
501-757, Korea
Phone: 82-62-220-6570, Fax: 82-62-225-8578
E-mail: lscmd@jnu.ac.kr
Received: Feb. 20, 2012
Revised: Apr. 13, 2012
Accepted: Jun. 27, 2012
CC

It is identical to the Creative Commons Attribution Non-Commercial

License (http://creativecommons.org/licenses/by-nc/3.0/).

Hemoptysis severity ranges from asymptomatic condition to airway obstruction due to hemoptysis. While
only the severe (range, 100 mL/24 hr1,000
mL/24 hr2,4-8) expectoration of pure blood is called hemoptysis, it generally includes bloodtinged or blood
1
streaked sputum . Typically, 600 mL/24 hr is considered as massive hemoptysis9,10, but 100 mL/24 hr is
6,7
also sometimes referred to as massive hemoptysis .
Conservative treatment, bronchial artery embolization
(BAE), and surgical treatment are available. However,
it is often the case that conservative treatment fails to
control bleeding; on the other hand, surgical methods,
such as pneumonectomy, are difficult to perform and
are associated with high postoperative in-hospital
mortality. With good immediate success rate for hemostasis, BAE is effective, but its long-term success rate is

107

BR Lee et al: Analysis of patients with hemoptysis in a tertiary referral hospital

3,11,12

undesirable
. A large number of studies have been
conducted on the prognostic factors influencing the curative effects of BAE, but so far with no conclusive re5,13
sults . It is also difficult to determine the appropriate
treatment method because most of hemoptysis patients
have chronic lung disease and poor performance status.
In this study, we investigated the clinical characteristics and etiology of hemoptysis in a hospital-based series of Korean patients. We describe the type of examinations used for diagnosis, the treatment modalities, and
outcomes.

Materials and Methods

We reviewed the medical records of patients admitted
to the Chonnam National University Hospital between
January 2005 and February 2010 with hemoptysis.
The inclusion criteria were as follows: diagnosis of
hemoptysis; patients treated with hemostatics (Hemocoagulase, Botropase; Hanlim Pharm. Co., Yongin,
Korea); patients who underwent chest computed tomography (CT); and patients who were actually treated
for hemoptysis. Based on the examination of the medical and radiotherapy records, an analysis was made on
the etiology of disease, smoking history, past medical
history, physical examination, chest radiography and
CT, sputum smear test and culture, bronchoscopy and
histopathological examination, bronchial arteriography,
and postoperative histopathological examination.
In this study, hemoptysis was divided into mild (30
mL/24 hr), moderate (30 and 100 mL/24 hr), and
severe or massive (100 mL/24 hr) according to Fidan
6
et al. .
Active pulmonary tuberculosis was defined as positivity for acid-fast bacillus (AFB) on bronchoscopy aspirate smear test, positivity for Mycobacterium tuberculosis on tuberculosis culture, or positivity on tuberculosis polymerase chain reaction (TB-PCR) test. Bronchiectasis was diagnosed based on chest CT imaging,
and lung cancer was diagnosed based on histopathological examination.
When chest CT, bronchoscopy, or bronchial arteriog-

108

raphy could detect the bleeding site or cause, it was

defined as being helpful for diagnosis.
The follow-up period of patients was based on the
last day of visit, and the success rate of hemoptysis control was determined by dividing the term largely into
short-term and long-term.
Short-term results were assessed based on careful observation of patients for 1 month (30 days or less) after
first-line treatment and were classified into two categories: success, indicating complete cessation of hemoptysis during 1 month (30 days or less); and recurrence12.
Treatment failure was defined when moderate bleeding
or worse continued three days after first-line treatment,
and included the cases where the second-line treatment
was performed, or the patient was transferred, discharged, or died without second-line treatment. When
a patient was discharged because of mild hemoptysis
three days after first-line treatment and did not need
second-line treatment for hemoptysis, it was not considered as treatment failure. Recurrence included treatment
failure, and was defined as single or multiple episodes
of hemoptysis. Long-term results were evaluated in patients who could be followed for at least 1 month.
Successful long-term control was defined as the successful control of hemoptysis without recurrence for the follow-up period (longer than 1 month). The same patient
could be included in both short-term and long-term
groups. In-hospital mortality was assessed in patients
with long-term follow-up.
In addition, the patients were divided into conservative treatment, BAE, and surgical treatment group,
depending on their first-line treatment regardless of the
cause. Follow-up period of conservative treatment was
based on the day of hospital admission. To compare
the differences between short-term control, long-term
control, in-hospital mortality, and duration of hospitalization, we performed statistical analyses.
For the statistical analysis, the SPSS version 18.0
(SPSS Inc., Chicago, IL, USA) program was used. The
continuous variable data were presented with mean
standard deviation. In addition, ANOVA test was performed to compare the hospitalization duration of each

Tuberculosis and Respiratory Diseases Vol. 73. No. 2, Aug. 2012

group and the chi-square test was carried out for the
analysis of outcomes. A p-value less than 0.05 was considered to be statistically signifiant. To verify the compounding factors between the risk factors whose characters were diverse confounding variables, we did multivariate analysis using logistic regression analysis with
95% confidence interval.

lung abscess, necrotizing pneumonia, pulmonary thromboembolism, pulmonary sequestration, arteriovenous

malformation, catamenial pneumothorax, etc.
As for the causes of 115 massive hemoptysis patients,
39 cases were bronchiectasis (39.9%), the highest frequency, followed by 24 cases of active pulmonary tuberculosis (20.9%), 16 cases of pulmonary fungus ball
(13.9%), 7 cases of lung cancer (6.1%), 18 cases of other causes (15.7%), and 11 cases of unknown causes
(9.6%). The causes of mild and moderate hemoptysis
are as follows, with no significant difference (p=0.47).
Most of the patients treated conservatively, but if there
was more bleeding present, BAE or surgery was more
commonly performed than conservative treatment (p
0.0001) (Table 1).

Results
1. Clinical characteristics
Of a total of 221 patients, 145 (65.6%) were male and
76 (34.4%) female with average age of 57.915.6.
As a past medical history, 58 patients had high blood
pressure (26.2%), 28 patients diabetes (12.7%), 13 patients both high blood pressure and diabetes (5.9%),
and 80 patients had the history of pulmonary tuberculosis (36.2%).
The follow-up period was 14.1212.59 months.

3. Diagnostic evaluation
Chest CT was performed for all patients (221 cases),
of which pulmonary lesions were detected in 206 cases
(93.2%). Bronchoscopy was performed for 106 cases
(48.0%), of which 64 cases (60.0%) were helpful for
diagnosis. Bronchial arteriography was performed for
44 cases (18.6%), of which 41 cases (93%) were helpful
for diagnosis.
When an active pulmonary tuberculosis was suspicious from chest CT, a test for sputum or bronchoscopy
aspirate was conducted. Active pulmonary tuberculosis
was defined as patients who were positive for AFB from
microscopic examination of stained smears or positive

2. The causes and treatment methods of hemoptysis

Regarding the amount of hemoptysis, 70 cases out of
221 cases were mild (31.5%), 36 cases moderate
(16.2%), and 115 cases massive hemoptysis (52.0%).
As for the causes, 72 cases were bronchiectasis
(32.6%), 41 cases active pulmonary tuberculosis
(18.5%), 24 cases fungus ball (10.8%), 13 cases lung
cancer (5.9%), 45 cases other causes (20.3%), and 26
cases unknown cause (11.7%). Other causes included
Table 1. The causes and treatment methods of hemoptysis

Mild
Cause

Treatment

Bronchiectasis
Active pul TB
Lung cancer
Fungus ball
Idiopathic
Miscellaneous
Conservative tx
BAE
Surgery

22
11
5
3
10
19
62
5
3

(31.4)
(15.7)
(7.1)
(4.3)
(14.3)
(27.1)
(88.6)
(7.1)
(4.3)

Moderate

Severe

11
6
1
5
5
8
30
5
1

39
24
7
16
11
18
69
32
14

(30.6)
(16.7)
(2.8)
(13.9)
(13.9)
(22.2)
(83.3)
(13.9)
(2.8)

(33.9)
(20.9)
(6.1)
(13.9)
(9.6)
(15.7)
(60.0)
(27.8)
(12.2)

Values are presented as number (%).

pul TB: pulmonary tuberculosis; tx: treatment; BAE: bronchial artery embolization.

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BR Lee et al: Analysis of patients with hemoptysis in a tertiary referral hospital

Table 2. The methodology of diagnosis

Chest CT
Performed
Bronchiectasis
Fungus ball
Lung cancer
Active pul TB
Miscellaneous
Idiopathic
Total

72
24
13
41
45
26
221

(100)
(100)
(100)
(100)
(100)
(100)
(100)

Bronchoscopy

Positive result
72
24
13
41
44
12
206

(100)
(100)
(100)
(100)
(98)
(46)
(93.2)

Performed
34
18
6
14
19
15
106

(47)
(75)
(48)
(34)
(42)
(58)
(48)

Bronchial arteriography

Positive result
24
4
6
10
14
6
64

(70)
(22)
(100)
(71)
(73)
(40)
(60)

Performed
22
4
0
12
4
2
44

(30)
(16)
(0)
(29)
(8)
(7)
(18.6)

Positive result
21
4
0
12
4
0
41

(95)
(100)
(0)
(100)
(100)
(0)
(93)

Values are presented as number (%).

CT: computed tomography; pul TB: pulmonary tuberculosis.

for mycobacterium tuberculosis from tuberculosis culture, or positive for TB-PCR. Among 41 cases of active
pulmonary tuberculosis, all three kinds of test-positive
cases were 5, two kinds of test-positive cases were 10
(1 case positive for culture and AFB, 1 case positive for
culture and PCR, 8 cases positive for PCR and AFB),
and 26 cases were positive for only one kind of test
(1 case positive for only culture, 5 cases positive for
only PCR, 20 cases positive for only AFB).
All 72 cases of bronchiectasis were diagnosed by
chest CT. Bronchoscopy was performed for 34 cases
(47.2%), of which 24 cases (70%) showed abnormalities. Bronchial arteriography was performed for 22 cases
(30%), of which 21 cases (95%) were detected for the
bleeding site.
All 24 cases of fungus ball were also diagnosed by
chest CT. Bronchoscopy was performed for 18 cases
(75%), of which 4 cases (22%) were detected for active
bleeding from the bronchus. Bronchial arteriography
was performed for 4 cases (16%), of which artery embolization was performed for all 4 cases after checking offending vessels.
In lung cancer, all 13 cases showed abnormalities
from chest CT. Bronchoscopy was performed for 6 cases (46%) and all the 6 cases were helpful for the
diagnosis. The final diagnosis was made by sputum cytology test, biopsy, or percutaneous fine-needling.
Of the 26 cases with unknown cause, 12 cases
showed non-local abnormalities (e.g., hemorrhagic as-

110

pirate, etc.) from chest CT and 14 cases were normal.

Bronchoscopy was performed for 15 cases, of which 6
cases showed the evidence of previous bleeding without any clear cause (Table 2).

4. Treatment outcome according to the amount of

hemoptysis
In the case of mild hemoptysis, 67 cases (95.7%) out
of 70 cases were controlled during 1 month, while 34
cases (94.4%) out of 36 cases were controlled in moderate hemoptysis. In the case of massive hemoptysis, 94
cases (81.7%) out of 115 cases were controlled, showing a higher failure or recurrence rate compared to mild
and moderate hemoptysis (p=0.008) (Table 3).
There were 161 cases of conservative treatment
(72.9%), 42 cases of BAE (19.0%), 18 cases of surgical
treatment (8.1%).
Of the 221 cases, only 168 cases were available for
long-term follow-up because the 53 cases of follow-up
loss were excluded from the analysis.

5. Treatment outcome according to the treatment

method
The short-term and long-term control, in-hospital
mortality rates were investigated according to treatment
method. In the short-term control, the success rate of
conservative treatment group was 88.2%, BAE group
92.9%, surgical treatment group 88.9%, showing that the
success rate of BAE was significantly high (p=0.04). As

Tuberculosis and Respiratory Diseases Vol. 73. No. 2, Aug. 2012

for the success rate of the long-term control, the conservative treatment group was 80.2%, BAE group 63.6%,
surgical treatment group 78.6%, without any significant

difference (p=0.135). In addition, there was no statistical difference in the in-hospital mortality (p=0.873)
(Table 3).

Table 3. Treatment outcome according to the amount of hemoptysis, treatment method, and leading cause
Short-term control

Long-term control
p-value

Success
Amount
Mild
Moderate
Severe
Treatment
Conservative tx
BAE
Surgery
Cause
Bronchiectasis
Active pul TB
Fungus ball
Lung cancer
Idiopathic
Miscellaneous
Total

Recurrence

Success

Recurrence

43 (76.8)
21 (84.0)
65 (74.7)

13 (23.2)
4 (16.0)
22 (25.3)

97 (80.2)
21 (63.6)
11 (78.6)

24 (19.8)
12 (36.4)
3 (21.4)

0.008
67 (95.7)
34 (94.4)
94 (81.7)

3 (4.3)
2 (5.6)
21 (18.3)

142 (88.2)
39 (92.9)
16 (88.9)

19 (11.8)
3 (7.1)
2 (11.1)

66
36
19
9
26
39
195

6
5
5
4
0
6
26

p-value
Alive

Death

0.625

0.04

0.117
52 (92.9) 4 (7.1)
24 (96.0) 1 (4.0)
73 (83.9) 14 (16.1)

0.135

0.055
(91.7)
(87.8)
(79.2)
(69.2)
(100)
(86.7)
(88.2)

In-hospital mortality
p-value

0.873
107 (88.4) 14 (11.6)
29 (87.9) 4 (12.1)
13 (92.9) 1 (7.1)

0.281

(8.3)
(12.2)
(20.8)
(30.8)
(0)
(13.3)
(11.8)

45
28
10
8
14
24
129

(77.6)
(84.8)
(76.9)
(80.0)
(87.5)
(63.2)
(76.8)

13
5
3
2
2
14
39

(22.4)
(15.2)
(23.1)
(20.0)
(12.5)
(36.8)
(23.2)

0.001
56
30
10
5
15
33
149

(96.6) 2
(90.9) 3
(76.9) 3
(50.0) 5
(93.8) 1
(86.8) 5
(88.7) 19

(3.4)
(9.1)
(23.1)
(50.0)
(6.3)
(13.2)
(11.3)

Values are presented as number (%).

tx: treatment; BAE: bronchial artery embolization; pul TB: pulmonary tuberculosis.

Table 4. Multivariate analysis of different variables

Short-term control

Long-term control

In-hospital mortality

Variables
OR (95% CI)
Gender
Age
Amount

Treatment

Cause

Female
Male
50 yr
50 yr
Mild
Moderate
Severe
Conservative tx
BAE
Surgery
Idiopathic
Active pul TB
Lung cancer
Bronchiectasis
Fungus ball
Miscellaneous

1
0.84 (0.393.15)
1
10.99 (1.3688.97)
1
1.31 (0.208.49)
5.93 (1.6121.79)
1
0.93 (0.322.76)
0.23 (0.031.94)
1
3.02 (0.3228.61)
11.34 (1.03124.46)
2.22 (0.2420.20)
6.26 (0.6461.19)
4.88 (0.5344.80)

p-value

0.835
0.025
0.777
0.007
0.899
0.177
0.336
0.047
0.478
0.115
0.161

OR (95% CI)
1
2.00 (0.914.39)
1
1.413 (0.583.47)
1
0.61 (0.162.26)
1.14 (0.462.85)
1
2.87 (1.097.55)
0.78 (0.193.23)
1
0.79 (0.079.37)
1.73 (0.1028.59)
1.47 (0.1415.7)
1.66 (0.1223.65)
3.74 (0.3341.86)

p-value

0.083
0.451
0.459
0.779
0.032
0.734
0.854
0.703
0.750
0.707
0.285

OR (95% CI)
1
0.77 (0.242.43)
1
2.23 (0.4311.60)
1
0.61 (0.066.64)
3.64 (0.9014.77)
1
1.29 (0.335.03)
0.37 (0.043.30)
1
1.33 (0.1214.50)
24.49 (1.98303.07)
0.56 (0.056.84)
4.13 (0.3548.49)
3.14 (0.3230.83)

p-value

0.656
0.339
0.687
0.071
0.717
0.370
0.817
0.013
0.650
0.260
0.327

OR: odds ratio; CI: confidence interval; tx: treatment; BAE: bronchial artery embolization; pul TB: pulmonary tuberculosis.

111

BR Lee et al: Analysis of patients with hemoptysis in a tertiary referral hospital

6. Treatment outcome according to the leading cause

In the short-term control, the success rate of bronchiectasis was 91.7%, the highest, while in the longterm control, the success rate of unknown cause was
the highest at 87.5%, without any significant difference.
In the in-hospital mortality analysis, in-hospital mortality
rate of lung cancer was significantly high (p=0.001)
(Table 3).

7. Multivariate analysis of different variables

In the multivariate model, amount of hemoptysis and
lung cancer were independently associated with shortterm recurrence. BAE was associated with long-term recurrence, and lung cancer was associated with in-hospital mortality (Table 4).

8. Duration of hospitalization according to treatment

method
A comparison was made for the duration of hospitalization for each treatment group. The hospitalization
duration of conservative treatment was 7.47.0 days
(range, 153 days), BAE group 14.915.8 days (range,
171 days), surgical treatment group 20.916.3 days
(range, 781 days), indicating that the hospitalization
duration of conservative treatment was significantly
shorter than other treatment groups (p=0.005).

Discussion
Hemoptysis is a bleeding from the bronchial or pulmonary artery, which supply blood to the lungs, due
to injury or damage induced by diseases of the bronchi
1,2,4
or lungs .
In most cases, hemoptysis is resolved within 24 hours
in the absence of treatment; mild to moderate hemoptysis is not considered an emergency condition, and the
main concern is to identify the underlying cause.
Massive hemoptysis, however, can cause acute respiratory failure from the blood-filled peripheral airway and
alveoli, leading to 1060% of in-hospital mortality from
7
bleeding or suffocation . For the treatment of massive

112

hemoptysis, surgical dissection of the bleeding site

would be the most effective method. However, if surgery is not possible due to ongoing hemoptysis, chronic
or diffuse lung disease, pulmonary dysfunction, unresectable cancer, or rebleeding after surgery, con5,14,15
.
servative treatment is the only option
In this study, 161 (72.9%) out of 221 cases had conservative treatment; bleeding was controlled in 142
(88.2%) of those cases. During the follow-up period, 19
cases had rebleeding, of which 13 cases succeeded in
controlling the bleeding with conservative treatment, 3
cases had BAE, 1 case had surgery, and 2 cases died.
If bleeding was excessive, BAE or surgery were more
commonly performed than conservative treatment. For
the treatment of massive hemoptysis, surgery was performed in 14 cases (14%) and BAE was performed in
32 cases (27.8%). The remaining 69 cases (60%) were
treated conservatively. Of these, 35 cases were inoperable (poor lung function in 13 cases, hemodynamic
instability in 11 cases, diffuse lesions in 7 cases, and
unresectable cancer in 4 cases).
16
Abal et al. reported that the most frequent underlying disease of hemoptysis was bronchiectasis, followed by inactive pulmonary tuberculosis and active
12
pulmonary tuberculosis. Swanson et al. reported bronchiectasis as the most frequent, followed by pulmonary
arterial hypertension and malignant tumor. In Korea,
the most common causes of hemoptysis are pulmonary
tuberculosis and bronchiectasis1,2, which seems to be
due to the fact that the prevalence of pulmonary tuberculosis in Korea is higher than in more developed
countries. The most common cause of hemoptysis in
this study was also bronchiectasis, followed by pulmonary tuberculosis, when excluding other diseases. The
main cause of massive hemoptysis was bronchiectasis,
too. The finding of bronchiectasis as the main cause for
hemoptysis in our study is probably secondary to remote nonactive infection by M. tuberculosis or other infectious agents. In addition, since our study population
consisted mainly of outpatients, the frequency of bronchitis patients was low.
CT has been shown to be accurate in the diagnosis

Tuberculosis and Respiratory Diseases Vol. 73. No. 2, Aug. 2012

of a wide range of bronchial abnormalities, including

central tumors and peripheral lesions such as bron17,18
chiectasis . Bronchoscopy is a considerably valuable
method in locating the site of bleeding, removal of obstructive clots, direct visualization of endobronchial tumors, foreign bodies, granulomas, and infiltrations. It also allows collection of histologic samples, but is not
useful in detecting peripheral tumors19. Bronchial arteriography can localize potential bleeding sites and treat
2
the bleeding by embolization . In our study, CT had the
best yield in the search for the cause of hemoptysis,
and was found more valuable than bronchoscopy in the
diagnosis of bronchiectasis, fungus ball, and active pulmonary tuberculosis.
14
Since BAE was first reported by Rmy et al. in 1977,
it has been widely used because it can stabilize the condition of patients, gaining time for the preparation of
surgery for acute hemoptysis, along with temporary
treatment. The early success rate of BAE is 73
98%5,13,14,20,21. In Korea, the early success rate is 95%,
15
and long-term success rate is 36% . In our analysis, the
first-line success rate of BAE was 92.9%, while the
long-term success rate was 63.6%, without statistical
difference. Higher long-term recurrence rate may be
due to incomplete embolization, revascularization, or
recanalization.
In the comparison of the conservative treatment,
bronchial artery embolization, surgical treatment, and
the concurrent treatment of bronchial artery embolization and surgery, short-term control showed the highest
success rate with bronchial artery embolization, which
is in agreement with previously reported results. However, surgical treatment was more efficient than conservative treatment, indicating that it might be indicated
for patients with clinically stabilized condition. The reason that the concurrent treatment group of bronchial artery embolization and surgical treatment was low in its
success rate was that it failed in controlling bleeding,
resulting in higher morbidity and mortality due to hypovolemic shock or pulmonary dysfunction.
As for the long-term control, no differences were
found between groups. Since a considerable number of

hemoptysis patients had pulmonary dysfunction due to

chronic lung diseases, such as tuberculosis, and had
concomitant chronic diseases, such as diabetes and hypertension, they did not show any difference in the
long-term observation.
11
Kim et al. described underlying lung disease and
amount of bleeding as reliable risk factors for the recurrence, in a study involving 75 patients with a result
estimating 54.5% of rebleeding rate after 3 years. In this
study, the amount of hemoptysis had some statistical relation with the recurrent event and lung cancer tended
to have more recurrence rate compared to other causes.
In the comparison of hospitalization duration by
group, conservative treatment group was the shortest
among other groups. This is an expected result in that
the patients who are clinically stabilized and have a
small amount of hemoptysis would first try conservative
treatment. However, the short-term success rate was
higher in the BAE group or surgical treatment group
than conservative treatment group. This can be attributed to the fact that the observation period increases
with the type of treatment, and not with the improvement of hemoptysis.
This study has several limitations, particularly its retrospective design. Furthermore, the evaluation and therapeutic decisions were not based on a preset protocol
but rather on the clinical experience of each attending
physician. It was conducted in a referral center with extensive experience with hemoptysis, which may limit
the generalization of our results. A referral center may
select the most severe patients, who are presumed to
have a worst prognosis. Conversely, a referral center
may certainly induce a better management, in terms of
resource facilities, therefore contributing to a better
prognosis.
This study is of significance because no previous
study has comprehensively investigated the cause of hemoptysis, and not many studies have compared the efficacy and outcomes of currently available treatment
methods for hemoptysis.

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