Haemoptysis in Primary Care: Differential Diagnosis and Management

Haemoptysis—the coughing up of blood originating from the lower respiratory tract—can range from mild and self-limiting to indicative of serious pathology. Clinically, it is vital to differentiate true haemoptysis from haematemesis (blood vomited from the gastrointestinal tract) or pseudohaemoptysis (blood coughed up from a nasopharyngeal or oral source).

In adult primary care, respiratory infections are responsible for the majority of haemoptysis cases (around 60%), though other important causes include chronic inflammatory airway disease, pulmonary vascular disorders, and malignancy. GPs play a key role in the initial assessment of severity—particularly identifying red flags—and in conducting appropriate investigations (e.g. chest radiography) to uncover underlying causes.

In this structured overview, we will explore the key differential diagnoses for haemoptysis in adults, highlighting distinguishing clinical features and recommending evidence-based primary care management strategies, including initial treatment approaches and referral guidance.

Red Flag Features (Urgent Referral Indicators)

Early identification of high-risk features is critical. Red flags in a patient with haemoptysis that warrant urgent referral or emergency management include