Hello Thanks for writing to H.C.M. for your query. I have gone through your query regarding cough and sometimes mixed with blood. You are a smoker and your tonsils are also of big size. You are not clear about blood from where it is comming, is it from lungs or from tonsils ? Your ENT doctor has advice you for tonsillectomy as you are mouth breather. To know from where blood is comming you should do these investigations- (a) X-Ray chest -( P.A.view ) (b) Culture and sensitivity of throat swab. (c) Diagnostic nasal endoscopy and pharyngoscopy. A thorough clinical examination of throat, nasopharynx, tonsils, larynx and chest and there clinical co-relation with above investigation s result will confirm the diagnosis and that may be accordingly manage. Regards.