Epidemiology of haemoptysis in Italy: A prospective observational study

Haemoptysis etiologies vary widely among studies (Mondoni M et al., Eur Respir J 2016; 47:348-50). Bronchoscopy plays a key role in localizing the bleeding source (Sakr L, et al., Respiration2010; 80:38-58). We conducted a prospective, multicentre, observational study investigating hemoptysis etiology in association with the severity of the symptom. We also studied the ability of bronchoscopy to detect the bleeding source ( i.e. , lung and lobe) in association with the time of endoscopic examination. From July 2013 to September 2015, 475 patients, whose mean (SD) age was 64.6 (16.7) years, were enrolled in five Italian lung diseases hospital units. Pneumonia (20.4%), lung cancer (17.1%), and bronchiectasis (14.7%) were the most frequent causes of haemoptysis. In contrast to recent findings (Abdulmalak C, et al., Eur Respir J, 46:503-11) idiopatic haemoptysis accounted only for 8.6% of all causes. Lung cancer and pneumonia were the most frequent causes of moderate-severe and mild bleeding, respectively. When performed within 48 hours from the last haemoptysis episode, bronchoscopy showed a higher detection ability than after 48 hours (lung: 69/130 (53.1%) vs. 74/213 (34.7%), P: 0.001; lobe: 55/131 (42.0%) vs. 59/215 (27.4%), P: 0.005). However, no differences were found when performed within 24 vs. within 48 hours (lung: 33/58 (56.9%) vs. 69/130 (53.1%), P: 0.63; lobe: 28/59 (47.5%) vs. 55/131 (42.0), P: 0.48). Pneumonia is the leading cause of haemoptysis in our Italian cohort, while lung cancer is the most frequent cause of severe bleeding. When performed within 48 hours from the last haemoptysis episode, bronchoscopy shows a better ability to detect the bleeding source (both the lung and the lobe).