PURPOSE: Bronchoscopic evaluation of hemoptysis in the advanced elderly, defined as persons aged >75 years, has not been previously characterized. We wished to determine the etiology and clinical characteristics of hemoptysis in the advanced elderly compared to those who are younger.
METHODS: We performed a retrospective case control analysis of 70 adults (age greater than 18 years), 35 patients (age < 75years) and 35 patients (age > 75 years), who underwent bronchoscopy for hemoptysis at a tertiary academic hospital. We performed a comparison of etiology and multiple clinical characteristics using Chi-square analysis.
RESULTS: Advanced elderly patients, presenting with hemoptysis, are more likely to have lung cancer (11/35 [31%] versus 4 /35 [8.5%] [Chi-square 4.2, p=0.041]) or infection/bronchitis (14/35 [40%] versus 4/35 [8.5%] [Chi-square 7.5, p=0.006]) as an etiology in comparison to younger patients. Although significantly more patients age > 75 years had received warfarin compared to patients age < 75 years (22.9% versus 5.7%, Chi-square 4.2, p=0.04), anticoagulation was not associated with the diagnoses of lung cancer (1/11 versus 0/4) or infection/bronchitis (3/14 versus 0/4). Patient's < 75 years of age were more likely to have a cryptogenic etiology for their hemoptysis compared to older patients (14/35 versus 4/35, Chi-square 7.5, p=0.006).
CONCLUSION: Advanced elderly patients are more likely than younger patients to have lung cancer or infection/bronchitis as an etiology of their hemoptysis. The use of oral anticoagulation is also more likely, but is not associated with a diagnosis of lung cancer or infection/bronchitis in this age group.
CLINICAL IMPLICATIONS: Lung cancer and infection/bronchitis are likely etiologies of hemoptysis in the advanced elderly. The use of warfarin in this age group does not appear to unmask occult lung cancer or affect bleeding associated with infection or inflammation in the airways.
DISCLOSURE: Michael Boyd, No Financial Disclosure Information; No Product/Research Disclosure Information