Bronchoscopy: Indications, Benefits, Preparation, Procedure, Results and Alternative Tests

It is a test that is generally used for the diagnosis, review and treatment of various conditions associated with the respiratory tract, that is, the bronchi and also the lungs.

In summary, a bronchoscopy is a study (procedure) where a doctor or specialist will look at the large airways (the trachea and bronchi). These are the main tubes that carry air to your lungs.

A fiberoptic bronchoscope is the device generally used. This is a slim, flexible telescope. It is as thin as a pencil. The bronchoscope is made of a flexible fiberoptic material and has a light source and a camera on the end.

Most bronchoscopes are compatible with color video, which helps the doctor document their findings.

The bronchoscope is inserted through the nose or mouth, down the back of the throat, into the windpipe, and into the bronchi.

The fiber optic allows the light to shine around the curves in the bronchoscope and thus the doctor can clearly distinguish within the airways.

A rigid bronchoscope is used much less often. It is like a thin, straight telescope. It may be necessary for some procedures and in children. It requires general anesthesia. (A fiberoptic bronchoscope only requires sedation.)

Both types of bronchoscope have a side channel under which thin instruments can pass. For example, a fine-grip instrument can be passed to take a small sample (biopsy) from the inner lining of a bronchus or from structures near a bronchus.

Indications

There are several reasons to have a bronchoscopy. For example, to help make a diagnosis if you have a persistent cough or spit up of blood and the cause is unclear.

If you have a shadow on a chest X-ray or the doctor sees a growth or strange-looking area in a bronchus, the doctor may take a small sample (a biopsy) during a bronchoscopy.

The sample is then examined under a microscope to help decide whether problems such as inflammation, infection, or cancer might be responsible for your symptoms. Bronchial lavage is also sometimes done during a bronchoscopy to help diagnose certain lung conditions.

As mentioned earlier, thin instruments can be passed through the lateral canal of a bronchoscope. Various instruments can do various procedures, for example:

  • To remove a small object (such as an inhaled peanut) that has become lodged in an airway.
  • To insert a small tube called a stent to open a collapsed airway.
  • To remove a growth that is blocking an airway.

Profits

  • Copious fluid can be eliminated from the lungs.
  • The doctor may insert instruments into the scope to treat abnormalities or remove tissue samples (biopsy) for further testing.

What happens during a bronchoscopy?

This is generally done as an outpatient or day case. The doctor will numb the inside of your nose and the back of your throat by spraying a little local anesthetic. This may seem a bit off putting.

Also, you will usually be given a sedative to help you relax. This is usually given by injection into a vein in the back of the hand or arm. The sedative may cause drowsiness, but it is not a general anesthetic and does not make you sleep. However, you are unlikely to remember anything about bronchoscopy if you have a sedative.

You may be hooked up to a monitor to monitor your heart rate and blood pressure during the procedure. A device called a pulse oximeter can also be put on a finger. This does not hurt, it checks the oxygen content of the blood and will indicate if you need extra oxygen during the bronchoscopy.

Soft plastic tubes may be placed just inside your nostrils to provide oxygen during the procedure.

The doctor will insert the tip of the bronchoscope into one of your nostrils and then gently guide it down the back of your throat into your windpipe. (It is sometimes passed through the mouth instead of the nose if you have narrow nasal passages.) The bronchoscope can cause coughing.

The doctor looks down the bronchoscope and inspects the lining of the trachea and the main bronchi (the main airways). Bronchoscopes transmit images through a camera attachment onto a TV monitor for the doctor to view.

The doctor may take one or more samples (biopsies) of parts of the inner lining of the airways, depending on why the test is being done and what they see. This is painless. The biopsy samples are sent to the laboratory for analysis and to be examined under the microscope.

Sometimes a bronchial lavage is done. This is a procedure where some fluid is sprayed into a section of the lung and then injected with a syringe. The fluid is then examined in the laboratory for abnormal cells and other particles that may be present in certain diseases.

The bronchoscope is gently pulled out. Sometimes other procedures are done, as described above.

The bronchoscopy itself generally takes about 20-30 minutes. However, you should wait at least two hours for the full appointment, to prepare, to allow time for the sedative to work, for the bronchoscopy itself, and to recover.

Rigid bronchoscopy

This requires general anesthesia, similar to that for minor operations. So after receiving anesthesia, the next thing you know is when you wake up in a recovery room.

Preparation

You may be advised not to take any medications that affect blood clotting, such as aspirin and warfarin , for a week before your bronchoscopy.

In addition to this, you should receive instructions from the hospital before the exam. These generally include:

  • That you should not eat or drink for several hours before the bronchoscopy.
  • That you will need someone to escort you home, as you will be drowsy from the sedative.

What can I expect after a flexible bronchoscopy?

If you have a sedative, it may take about an hour before you are ready to go home after the bronchoscopy is complete. The sedative will usually make you feel very nice and relaxed. However, you should not drive, operate machinery, or drink alcohol for 24 hours after taking the sedative.

You should not eat or drink anything for two hours after the bronchoscopy because your throat will still be numb. You will need someone to escort you home and stay with you for 24 hours until the effects have completely worn off. Most people feel able to resume normal activities after 24 hours.

The doctor can tell you what they saw before they left. However, if you’ve had a sedative, you may not remember what they said afterward. Therefore, you may want to have a close relative or friend who can remember what was said. The result of any biopsy may take a few days or weeks to come back.

Alternative tests

Alternative tests include X-ray exams, CAT scans, and MRI.

Are there any side effects or possible complications?

Most are done without any problem. Your nose and throat may be a little sore for a day or more afterward. You may feel tired or sleepy for several hours, caused by the sedative. There is a slightly higher risk of developing a throat or chest infection after a bronchoscopy.

If you had a biopsy, you may cough up a little blood a few times the next day. In rare cases, a bronchoscopy can damage the lung. This is more likely to occur if a specialized lung tissue biopsy is taken. This can sometimes collapse a lung. Serious complications from a bronchoscopy are extremely rare.

What should I report to my doctor?

Call your doctor or nurse immediately if you have any of the following complications:

  • Increased difficulty in breathing.
  • Increase in the amount of blood in your sputum.
  • Uncontrollable cough
  • Chest discomfort.
  • Chills or fever

You will receive special instructions from your doctor.

Normal results

Normal effects suggest normal cells and fluids are present. No foreign substances or blockages visible.

What abnormal results mean

Many disorders can be diagnosed with a bronchoscopy, including:

  • Infections of bacteria, viruses, fungi, parasites or tuberculosis.
  • Lung damage related to allergic-type reactions.
  • Lung disorders in which the deep lung tissues become inflamed due to the response of the immune system and then damaged. For example, changes can be found in sarcoidosis or rheumatoid arthritis.
  • Lung cancer or cancer in the area between the lungs.
  • Narrowing (stenosis) of the trachea or bronchi.
  • Acute rejection after a lung transplant.