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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.

University of Milan

M.D., Ph.D.

All Drugs and Chemicals

Dimercaprol

Patients with haemoptysis and negative/non-diagnostic CT scan (i.e. with focal peripheral lung fibrosis, calcified parenchymal nodules with a maximum diameter \<5 mm, linear subsegmental atelectasis, hilar-mediastinal lymph nodes with a short axis \<1 cm, pleural thickening/pleural calcification and focal area of emphysema with a diameter \<1 cm) for whom bronchoscopy is deemed necessary to obtain an aetiological diagnosis.

During bronchoscopy endobronchial biopsy, transbronchial biopsy, transbronchial needle aspiration, bronchial washing, bronchoalveolar lavage, EBUS-TBNA and EUS-B-FNA may be performed

Giulia Nalesso, MD

Pietro Candoli, MD

Claudio Sorino, MD

Giuseppe Cipolla, MD

Pierachille Santus, MD

Fabrizio Luppi, MD

Nadia Corcione, MD

Roberto Piro, MD

Rocco Trisolini, MD

Paolo Solidoro, MD

Alfons Torrego, MD

Conflicting evidence exist in the literature on the utility of bronchoscopy in patients with haemoptysis and negative/non-diagnostic chest CT scan.

The primary aim of this prospective, observational, multicenter study is to evaluate the utility of bronchoscopy in patients with haemoptysis and negative/non-diagnostic CT scans. Secondary aims are related to the utility of bronchoscopy to detect occult malignancies, the source of the bleeding and the clinical features of the cohort

Haemoptysis, i.e., coughing up blood from the airways, is a common and alarming symptom in the context of respiratory diseases. Studies conducted in Europe and North America in the last ten years have identified lung cancer (13.9-30.3%), bronchiectasis (6-21%) and low respiratory tract infection (4.2-40%) as the most common causes of the symptom. No international guidelines exist suggesting the optimal diagnostic work-up in patients with haemoptysis, based on demographics characteristics, risk factors (such as smoking history) and clinical presentation. The full diagnostic pathway of the symptom includes patient anamnesis, blood tests, chest X-ray, chest computed tomography (CT) scan and bronchoscopy. The 2020 international guidelines of American College of Radiology recommends performing chest CT scan with intravenous (IV) contrast or a CT angiography after the first episode of haemoptysis of any severity. Many studies recommend CT scan before bronchoscopy, underlining the diagnostic complementarity of the tests and the role of tCT as a guide for endoscopic examination. There is conflicting evidence in the literature on the utility of bronchoscopy in patients with a negative CT scan or in cases of CT showing non-specific or non-diagnostic benign findings (e.g., calcified parenchymal nodule, linear subsegmental atelectasis, pleural thickening). Due to this conflicting evidence, we deem necessary to conduct a prospective, observational, multicentre study. The primary aim is to evaluate the proportion of patients with haemoptysis and negative/non-diagnostic CT scans in whom bronchoscopy allows an aetiological (i.e., endoscopic and/or microbiological and/or anatomopathological) diagnosis.

The secondary objectives are:

* to evaluate the proportion of patients in whom bronchoscopy may detect occult endobronchial neoplasms (not detected with chest CT scan)
* to evaluate the proportion of patients in whom bronchoscopy may identify the source of the bleeding
* to evaluate the proportion of patients with haemoptysis and negative chest CT scan in whom bronchoscopic findings may induce variation in the treatment of the patients
* to evaluate the proportion of patients with a negative bronchoscopy at baseline, in whom a subsequent endoscopic examination performed during the follow-up for recurrent haemoptysis may allow an aetiological (endoscopic and/or microbiological and/or anatomopathological) diagnosis
* to evaluate the proportion of patients with negative CT scan and bronchoscopy in whom lung cancer may be diagnosed during the follow-up
* to evaluate the main clinical characteristics (e.g., severity, duration of haemoptysis) of patients with haemoptysis with negative chest CT scan and bronchoscopy, the rate and severity of symptom recurrence and the mortality rate after one year of follow-up in this cohort.

The study will be performed in twelve Respiratory Units throughout Europe. The study will last two years, and it is estimated to enroll at least 150 adult patients of any nationality referred for haemoptysis of unknown origin with negative/non-diagnostic chest CT scan, for whom bronchoscopy is deemed necessary to obtain an aetiological diagnosis. Patients will undergo pulmonary examination and blood tests (complete blood count, PT, PTT, urea, blood creatinine and CRP) before bronchoscopy. A chest CT scan with IV contrast is considered necessary, except for patients with absolute contraindications (renal failure, allergy to iodinate IV contrast). Only patients with chest CT scan performed within 72 hours from the last episode of haemoptysis will be enrolled in the study. Bronchoscopy will be performed within two weeks of the chest CT scan. All the enrolled patients will be followed-up for 12 months with a telephone interview at one, three, six and twelve months after the enrolment. In case of haemoptysis relapse, a clinical evaluation could be performed. Each centre will decide upon the subsequent diagnostic work-up.

blood, serum, bronchial/lung tissue, bronchial secretions, BAL fluid, lymph node aspirates

Utility of Bronchoscopy in Patients With Haemoptysis and Negative Chest CT Scan

Observational, Prospective, Multicentre Study on the Utility of Bronchoscopy in Patients With Haemoptysis and Negative Chest CT Scan

The primary aim of the study is to evaluate the proportion of patients with haemoptysis and negative/non-diagnostic CT scans in whom bronchoscopy allows an aetiological (i.e., endoscopic and/or microbiological and/or anatomopathological) diagnosis

To evaluate the proportion of patients in whom bronchoscopy may detect occult endobronchial neoplasms (not detected with chest CT scan)

To evaluate the proportion of patients in whom bronchoscopy may identify the source of the bleeding

To evaluate the proportion of patients with haemoptysis and negative chest CT scan in whom bronchoscopic findings may induce variation in the treatment of the patients

To evaluate the proportion of patients with a negative bronchoscopy at baseline, in whom a subsequent endoscopic examination performed during the follow-up for recurrent haemoptysis may allow an aetiological (endoscopic and/or microbiological and/or anatomopathological) diagnosis

To evaluate the proportion of patients with a negative chest CT scan and bronchoscopy in whom lung cancer may be diagnosed during the follow-up

To evaluate the main clinical characteristics (e.g., severity, duration of haemoptysis) of patients with haemoptysis with negative chest CT scan and bronchoscopy, the rate and severity of symptom recurrence and the mortality rate after one year of follow-up in this cohort.

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
Utility of Bronchoscopy in Patients With Haemoptysis and Negative Chest CT Scan	NCT05634200	Hemoptysis	Bronchoscopy	18 Years -	University of Milan

Spots Global Cancer Trial Database for haemoptysis

Every month we try and update this database with for haemoptysis cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for haemoptysis

Every month we try and update this database with for haemoptysis cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for haemoptysis cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.