Health chronicle: Hemoptysis, physical activity and hypotoxic diets

Dr. Lara Bilodeau

M.D., FRCPC

Pulmonologist

University Institute of Cardiology and Pneumology of Quebec Quebec Quebec (Quebec) Canada

Q: I have hemoptysis (pulmonary bleeding) quite frequently. I have the impression, perhaps wrongly, that they are the result of the practice of certain sports. In your opinion, is there a causal link between physical activity and hemoptysis? Should I consider quitting certain sports? Are hypotoxic, so-called anti-inflammatory diets (gluten-free diets, live food, etc.) and their benefits for people with CF relevant?

R: Mild hemoptysis (blood sputum) occurs frequently in people with cystic fibrosis. They are secondary to the chronic bacterial infection that causes an inflammatory reaction with the formation of blood vessels. Bleeding comes from bronchial arteries that rupture when coughing or are eroded due to inflammation. Very mild bleeding often resolves without intervention. Persistent bleeding is a symptom of pulmonary superinfection and requires you to consult your treatment team to find out what to do. Treatment involves taking antibiotics to fight bacteria in the lungs. Depending on the extent of the bleeding, it may be necessary to moderate respiratory physiotherapy and to temporarily stop certain medications that stimulate cough, such as hypertonic saline.

Approximately 4% of people with cystic fibrosis will experience massive hemoptysis (expectoration of at least 250 mL of blood in 24 hours) during their illness. People who experience such bleeding must be hospitalized and will often require an embolization of bronchial arteries, i.e. an operation that blocks the bleeding vessels.

The best way to try to prevent hemoptysis is to treat the chronic bacterial infection with the appropriate antibiotics. It is also important to take your enzymes and vitamins well since a vitamin K deficiency affects coagulation, which promotes bleeding. There is no recognized diet to prevent or cure hemoptysis. Rather, it is important to maintain a healthy weight and follow the recommendations of your nutritionist. With respect to physical activity, no sport has been identified as a cause of hemoptysis. However, if you notice that a particular activity seems to trigger hemoptysis on a recurring basis, it is best to refrain from doing that activity. It is also recommended to avoid strenuous physical activity when you have hemoptysis until the bleeding is resolved.

‍