Clubbed finger tips usually means the person has lung or heart disease. It only makes sense if he smokes a lot of cigarettes (2 packs is a lot). The more he smokes everyday, the higher chance he could get the disease. Just to be sure, you might want to do tests for lung and heart disease. The coughing up blood might be a the result of smoking. It really depends on his state of shape and all of that stuff.
