Basically, Pulmozym and HS can cause hemoptysis by causing lung inflammation. Note that chest pain is listed too as a side effect for Pulmozym (no clue about HS), which is another indication that it can cause an inflammatory reaction. You say that you were feeling heavy, I assume you had more inflammation than usual. You also say that you did your "normal" routine, so it's not your first time taking Pulmozym or HS, thus you have taken it without problem before. I don't think Pulmozym or HS are the cause. Inflammation, maybe due to an exacerbation might be the cause. I had hemoptysis since I was 14 years old (9 years ago!). It started happening when I was using turbohalers. I suspect that it was the suction was causing bleedings with inflamed lungs. The frequency of hemoptysis episodes has always been very variable but it increased over the years, as did the amount of blood when it happened. I would get them every 6-3-2-1 months, sometimes it would happen many times within a month, sometimes it would happen that I would have many episodes in a week then it would go away for 2 months, etc. The amount ranged from a tablespoon to many. The most serious episode I had was 2 years ago. I coughed up probably over 100mL of blood. It was pretty distressing. It really felt like the bleeding lung was drowning in blood. I couldn't take one breath without exhaling blood. Unlike the so many many many many episodes I had over the 7 years prior to that, it did not look like it was going to stop. I think it lasted 3 minutes of coughing up blood with every breath non-stop. That's when they decided to go see what was happening in there and decided that I needed an embolization (after 7 years of coughing up blood... no sh**!). The bronchoscopy showed nothing, but the X rays on the table in radiology while they were doing the bilateral embolization showed that my right lung artery was thrice as big as usual, while the left lung artery was twice as big as usual. That's caused by the chronic inflammation, a lot of blood is needed to feed that inflammation, so it causes arteries to develop and become bigger. Don't do like I did and don't wait for them to do something about it. Ask for your lungs to be checked. Ideally, you should go right now. You have to go the same day for them to be able to go see where it comes from.
Edit : It's very important that you stay calm when that happens. Higher heart rate and higher blood pressure are going to make it worse.
Also, they say to go to the ICU as soon as you cough up more than 3 tablespoons. I don't. I would always be in ICU if I did. I judge the severity of it by the amount and the consistency of the blood. Sometimes I will cough up more than 3 teaspoons of red but also thick blood, as if it was mixed with uninfected mucus. Of course that's not a good sign, but that's not something I get alarmed about as I know that those go away. It's when I cough up liquid, almost pure blood in greater quantity that I judge it as being more serious and consider going to the ER.Something I noticed too is that in the last 4 years, they often happened after having pleurisy. It's as if the inflamed tissues were bursting and "flushing the blood out"... not like menses of course, but in the way that once the blood has been evacuated, the pain from the inflammation is reduced by a lot. This isn't good at all though, since I think it's the kind of things that leave permanent damage...
