HEMOPTYSIS - CLINICIANS PERSPECTIVES

Clinicians who were interested and considerably experienced in assessing patients with hemoptysis were surveyed during a computer-assisted interactive presentation at the 1988 ACCP Annual Scientific Assembly. The approach to ambulatory patients with minor bleeding was consistent with recently published guidelines: fiberoptic bronchoscopy has a central role, with a less apparent impact of other new technologies. Although specific diagnostic results were significantly more useful (p < 0.01), even nonspecific bronchoscopy findings were thought to have clinical value. External factors such as medicolegal concerns and obligations to provide service were acknowledged to influence selection of patients for bronchoscopy, and community-based clinicians cited such effects more often than academicians (p < 0.02). Approaches to patients with massive hemoptysis reflected caution essential to acute management. Bronchoscopy was performed earlier (p < 0.01) than in patients with minor bleeding, but opinions differed regarding instrument selection, the best method of airway support, and the roles of interventional angiography. This survey suggests that real-world settings are addressed incompletely by published experiences accumulated in tertiary centers. Clarification of optimum approaches to patients with hemoptysis requires further input from practicing clinicians.