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Patients over 18 years of age presenting with hemoptysis at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) between the periods of 2005 to 2010.

Brian Grondin-Beaudoin, MD

Matthieu Poirier, MD

Amelie Blanchard, MD

Brian Grodin-Beaudoin, MD

The study consist of a retrospective analysis of the etiologies, investigations and outcomes of patients presenting between 2005 to 2010 with hemoptysis in a North-American Tertiary center.

RATIONALE:

Hemoptysis, mild or massive, is worrisome for both patients and physicians. The management is different depending on the causes, which are not well defined for the North American population. Despite the fact that this symptom is commonly reported in clinic, there are only a few studies published on this subject in the North-American population. Tuberculosis was a frequent cause of hemoptysis described in populations overseas, which seems less prevalent in the investigators center.

Also, there are no known official guidelines regarding the investigation and management of hemoptysis. The investigators hypothesized that the use of modern technology in a North American population may result in different findings and provide a more accurate diagnostic approach.

Therefore, the study compares the different etiologies of hemoptysis and investigation modalities used in patients presenting in a North-American tertiary center.

METHOD:

The investigators did a retrospective analysis of medical chart from patients with hemoptysis who visited the investigators center between 2005 and 2010. Each visit has been reviewed individually to describe the characteristics of patients, etiologies of hemoptysis and investigation modalities used. All-cause mortality at 2 years was also recorded.

Descriptive statistical analyses will conducted on the data available.

Etiologies, Investigations and Outcomes of Patients Presenting With Hemoptysis

Etiologies, Investigations and Outcomes of Patients Presenting With Hemoptysis in a North-American Tertiary Center at the Beginning of the 21st Century

Defining the prevalence of pulmonary diseases by measuring the percentage of patients presenting with hemoptysis caused by lung cancer, bronchiectasis, pulmonary embolism, arteriovenous fistula, pneumonia, bronchitis, tuberculosis, mycosis, heart failure, pseudohemoptysis, cryptogenic and other causes.

Determining the sensitivity in obtaining the etiology of the hemoptysis episode of each diagnostic modality that follows : chest X-ray, chest CT-scan and CT-angiography, bronchoscopy, ventilation-perfusion with single-photon emission computed tomography and pulmonary angiography in the diagnosis of different etiologies of hemoptysis.

All-cause mortality at 2 years after the diagnosis of hemoptysis.

Determining the percentage of patients who : never smoked, is an active smoker, former smoker or unknown status.

Determining the average age of the enrolled patients.

Determining the percentage of each gender of the enrolled patients.

Determining the median of the international normalized ratio (INR).

Determining the median of the partial thromboplastin time (PTT).

Determining the average of the platelet count measured per microliter of blood.

Université de Sherbrooke

Medical Doctor

Rare Diseases

Pulmonary Disease, Chronic Obstructive

Chronic Disease

Chronic Graft Versus Host Disease

Acute Graft Versus Host Disease

Chest X-ray

computed tomography of the chest

In patients with haemoptysis bronchoscopy will be performed with flexible bronchoscope. A systemic research of bleeding site and causes will be done. Microbiological or pathological sampling will be executed if clinically required. In selected patients, bronchoscopy might be performed with the rigid instrument or the flexible bronchoscope in intubated patients.

Bronchoscopy

Michele Mondoni, MD

Paolo Carlucci, MD

Stefano Centanni, MD, PhD

Haemoptysis is the coughing up of blood originating from the respiratory tract. It is a common and worrying clinical symptom which can be due to different aetiologies including lung cancer, tuberculosis, COPD, bronchiectasis, pneumonia, acute bronchitis or unknown origin (cryptogenic haemoptysis). Epidemiology and optimal diagnostic approach are largely unclear. Aims of this study are to define current epidemiology and to provide the best diagnostic approach by providing a diagnostic algorithm.

Epidemiology and Diagnosis of Haemoptysis: a Multicenter Study

Multicenter, Prospective, Observational Study on Epidemiology and Diagnosis of Haemoptysis

Prevalence of chronic obstructive pulmonary disease (COPD) in patients with haemoptysis will be assessed performing spirometry as described by European Respiratory Society Guidelines (European Respiratory Journal, 2005). COPD will be diagnosed in patient with a compatible clinical history (smoking history and frequent exacerbations) and the presence of a ventilatory obstructive defect as defined by a ratio of the forced expiratory volume in the first second and forced vital capacity (FEV1/FVC) \<70.

To define the prevalence of diseases in patients presenting with haemoptysis in relation to the use of drugs such as antiaggregants or anticoagulants.

To define the prevalence of diseases presenting with haemoptysis by measuring percentage of patients presenting with haemoptysis affected by lung cancer, tuberculosis, bronchiectasis, pneumonia, acute bronchitis, cryptogenic haemoptysis or other causes. Epidemiology will be analysed related to the severity of the symptom (mild haemoptysis: drops of blood or bloody sputum; moderate haemoptysis: \<500 ml/24 h, severe haemoptysis: 1-2 cups, as defined by Hirshberg et al. CHEST 1997).

Sensitivity, specificity, positive and negative predictive values of of chest X-ray, computed tomography (CT) scan and bronchoscopy executed alone versus the combination of the exams in the diagnosis of different causes of haemoptysis (lung cancer, tuberculosis, bronchiectasis, pneumonia, acute bronchitis, cryptogenic haemoptysis and other causes).

Every patient will be followed with scheduled visits and phone calls for 18 months since the first episode of haemoptysis. The percentage of patient with recurrence of haemoptysis, the severity of recurrence, will be measured and analysed by descriptive statistics.

Accuracy of bronchoscopy in localizing the side and the lobe source of the bleeding in relation to the timing of haemoptysis. The bronchoscopic findings will be analysed in relation to the timing of the bleeding (within 24 hours, between 24 and 48, 49 and 96 or over 96 hours after the occurrence of the symptom).

Every patient will be followed with scheduled visits and phone calls for 18 months since the first episode of haemoptysis. Patient survival will be measured and analysed by descriptive statistics.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Etiologies, Investigations and Outcomes of Patients Presenting With Hemoptysis	NCT02913365	Hemoptysis Haemoptysis Lung Disease Pneumonia Tuberculosis Bronchiectasis Respiratory Tra... Respiratory Tra... Bronchitis Mycobacterium I... Bronchial Disea... Pulmonary Hemor... Signs and Sympt... Signs and Sympt... Pathologic Proc... Mycosis Hemorrhage Lung Cancer Pulmonary Embol... Arteriovenous F...		18 Years -	Université de Sherbrooke
Epidemiology and Diagnosis of Haemoptysis: a Multicenter Study	NCT02045394	Lung Cancer Tuberculosis Bronchiectasis Pneumonia Acute Bronchiti... Chronic Obstruc... Cryptogenic Hae...	Chest X-ray computed tomogr... Bronchoscopy	18 Years -	University of Milan
Epidemiology and Diagnosis of Haemoptysis: a Multicenter Study	NCT02045394	Lung Cancer Tuberculosis Bronchiectasis Pneumonia Acute Bronchiti... Chronic Obstruc... Cryptogenic Hae...	Chest X-ray computed tomogr... Bronchoscopy	18 Years -	University of Milan

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