Hi, Noted your detailed history of being a smoker of meth and Marijuana for 30 years, painter by profession, heavy drinker, coughing up green phlegm with blood sometimes, though of COPD and has no insurance. Surely the smoking has caused changes in the respiratory system, more prone to infection, irritation and so on that cause secondary infection giving green phlegm and sometimes can be with blood if the inflammation is too much and when the phlegm separates from the mucosa. I would suggest you the following in such a situation: Get the consultation of a Pulmonologist for proper clinical evaluation, examination and further investigations if the money permits or you get a proper insurance or so. CT scan of chest. Send the phlegm for tests of gram staining, culture and sensitivity, for tuberculosis and as ordered. Bronchoscopy sometimes help. Pulmonary function tests with and without bronchodilators. Tests of blood. All these will lead to a proper diagnosis so that a proper guided management can be done. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. T. Chandrakant, General Surgeon