Background: Hemoptysis, which refers to the expectoration of blood from the lower respiratory tract, can be from benign self-limiting causes to life-threatening conditions. Traditional management strategies include identification and treatment of the underlying cause, protection of the airway, and supportive care. An antifibrinolytic agent, TXA has been used systemically to control bleeding in a variety of settings. Recently, nebulized TXA has emerged in the limelight due to its apparent potential for the management of hemoptysis through a direct effect on the bronchial mucosa. Methods: We conducted a prospective, controlled study of patients who presented to a tertiary care hospital with mild-to-moderate hemoptysis. Subjects were randomized into two groups: a control group receiving standard therapy and an intervention group receiving standard therapy plus nebulized tranexamic acid. Hemoptysis volume, frequency of bleeding episodes, clinical stability (vital signs, oxygen saturation), and length of hospital stay were evaluated. Safety parameters were also assessed, including any signs of bronchospasm or thromboembolic events. Results: A total of 100 patients were enrolled, with 50 in each group. The intervention group demonstrated a statistically significant reduction in hemoptysis volume (p < 0.05), shorter duration of bleeding episodes (p < 0.05), and reduced hospital stay compared to the control group. No major adverse events or thromboembolic complications were reported. Nebulized TXA was well tolerated, and no significant differences in oxygen saturation or pulmonary function were observed between the two groups. Conclusion: Nebulized tranexamic acid, as an adjunct to standard therapy, appears to be both safe and effective in reducing the severity and duration of hemoptysis. Further large-scale studies are warranted to confirm these findings and to delineate specific guidelines for dosing and duration of nebulized TXA therapy.