Coughing up Blood/Asthma/?

have had three episodes of coughing up blood in the past 3 weeks or so, two after exercise and once because of an athma attack. I had a chest x-ray after the first two incidents from exercising that showed hyperinflation (despite the fact my peak flow was 530, my best is 550 and my chest was clear). I was told to take a week off of training, and then see if it happened again. I had a bad attack Monday night and coughed up some bloody mucus after two nebulizer treatments. How likely is it that my asthma is causing this? I have severe asthma and have been on predinsone for the past two years (currently on 20mg BID because of the attack Monday night, normally hold at 20mg QOD these days) plus pulmicort, serevent, singualir, theophylline, allegra-d, rhinocort, and prilosec OTC. I'm 25, F , and never smoked although I grew up in a house with a smoker. Any ideas of a cause if is not my asthma causing the problem?

Thanks

[National Jewish Health]

Asthma does not cause one to have bloody sputum or mucus.  Coughed-up blood can originate in the upper respiratory tract, such as the nose, sinuses or nasopharynx, and it is not always easy for one to be sure of the source.  Whether benign, as a nosebleed, or a more serious cause, coughing up blood should be taken seriously and the cause determined.  This will require examination, first, by a lung specialist who will do a bronchoscopic exam including autofluorescence and perhaps order other tests, such as a CT scan of the lungs.  If there is no source of blood in the lungs or large airways, you should then have an ENT specialist exam.