Missed dose of Amikacin & sputum with blood.

I have had about 16 hemoptysis episodes over the course of the last year. I doubt skipping a dose of Amikacin (which I have never been prescribed) has anything to do with it. In my case, I only use the Aerobika for airway clearance because the saline and/or albuterol with the device cause me to have hemoptysis and required me to stop the use of those with the device. I suggest you see if the Amikacin is a contributing factor and note any relationship in the future. There may not be a correlation but, given my problems with the saline/albuterol, may be. Additionally, and oddly, I can have a hemoptysis episode solely using the Aerobika.

For some people, like me, hemoptysis is just a part of having bronchiectasis/MAC, mostly the bronchiectasis. I was pretty frightened with my first episode and went to the ER at the suggestion of my insurance company (it was late at night). The next 4 episodes -- I went to the ER due to my concern about the amount. My episodes aren't just a bit of red in sputum. They are large clots that scare a person beyond description and cover from 5-10 minutes, sporadically over that time. I now take pictures of the hemoptysis amounts to show my pulmonary/ID doctors so they can evaluate how bad it is and whether or not my treatment for bronchiectasis/MAC should be re-evaluated.

I have decided not to go to the ER again unless what I'm coughing up is over a tablespoon+ of pure blood, which could indicate a pulmonary embolism. My episodes have not stopped, although I have gone a month now without one, which isn't that unusual. Sometimes I'll go 3-4 months without an episode and then, all of a sudden, I'll have 2-3 in one month and sometimes back to back (in two days).

I hope this helps. I remember feeling the way you do but I'm still here, alive and kicking in spite of the hemoptysis. Wishing you well on this journey of ours!

I have not had an episode of hemoptysis since beginning the Azithromycin and Ethambutol for MAC in March 2023. When I added Arikayce in Sept 2023, I had very slight hemoptysis the first time. I have had none since then, and the episodes I did have before treatment were significant in quantity.
When I went to UT Tyler and began my treatment, I was initially advised to go easy on the Albuterol because it could aggravate hemoptysis. I was also told not to overdo fish oil because that can increase hemoptysis. I have not had any problems with them. I have read that nebulized saline can aggravate it in some. Maybe cut back to one vial of the saline to see if that helps. Hemoptysis is a recognized side effect of Arikayce, however, so you may need to check with doctors on this. Many doctors will reduce Arikayce use to three times weekly. That way, you are still getting its benefits without so many side effects. My doctor and nurse say that when you are having hemoptysis, you should stop nebulizing until it is cleared up.

Dear @formergardener and @pmmar1

Thank you so much for taking time to answer my questions and these soothing words, that is really calming me down! My pulmonologist also advised me to stop airway clearance for a few days. I will cut saline to once per day instead of twice. I did not know it may cause hemoptysis. Maybe I should keep 4ml instead of 8ml, which is my recent plan. that is very useful information@pmmar1@formergardener. The good news is that I only had a little blood this morning.

I think airway clearance / huff cough may be a contributing factor too. I changed my position to "upside down" for airway clearance for a moment and that was when hemoptysis happened!

@pmmar1 I also checked online and they say hemoptysis is not a severe situation, I hope you can get the situation controlled better and better too!

There are many small incidents on the way, but hopefully most of them can be overcome! Thanks again for your support!

Helen, you are welcome. I’m glad my words were helpful.
We’ll keep moving forward in spite of this issue, being positive along the way and without adding more stress to our lives. We certainly don’t need that! Best wishes!

Helen, hemoptysis can be scary but is not uncommon with bronchiectasis and the irritation from the various treatments. As long as it is not excessive and stops with temporary reduced airway clearance, you should not worry. It is true that this is just another little hiccup in this experience, but we learn how to navigate them and what we can do to minimize them!

If I am not mistaken, I think my pulmo said if the amount of blood was 1/2 cup then go to the ER. A tablespoon or pure blood with Bronchiectasis (give or take) does not seem urgent if it stops but 1/2 cup seems like alot. Maybe somewhere between those warrants ER?

After viewing my hemoptysis pictures, my Infectious Disease doctor at NJH told me that anything over 1+ tablespoons would warrant an ER visit. (Four tablespoons is .25 cup and that would really be an emergency -- to him). We'll hear different doctors tell us different things.

The doctor on call in the ER on my last visit last September told me that unless you are scared about the amount (I was for the first 4 episodes) that it isn't necessary to visit the ER. And that's the reason I'm not going to the ER again unless, as the on duty doctor suggested, I'm scared. Too long in the ER (sometimes 6 hours) is a bit much to me.

If the hemoptysis stops and doesn't continue, there is no need to go. The problem I have -- my episodes usually last from 5-10 minutes and I never know if they will continue or not. The blood is in large clots, which means I don't know whether or not I should be concerned.

Hopefully this helps you as you determine the seriousness of your hemoptysis. The information here is just from other points of view with doctors whom I have discussed this issue.