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What is Bronchoscopy?

Bronchoscopy is a procedure that helps in observing the air passage and lungs. It is usually performed by a pulmonologist (lung specialist) and involves the insertion of a small, thin and flexible tube (bronchoscope) with an attached video camera, through your mouth or nose, down the throat, into the windpipe (trachea) and eventually into lungs (bronchi and bronchioles).

A rigid bronchoscope is occasionally used for removing foreign bodies or blockages of the airway and performing a biopsy (obtaining samples) of tissue or mucus.

  1. Why is Bronchoscopy performed?
  2. How do you prepare for Bronchoscopy?
  3. How is Bronchoscopy performed?
  4. What do Bronchoscopy test results indicate?

Bronchoscopy is performed to determine the cause of breathing difficulties or lung problems, such as tumour, infection or bleeding. Bronchoscopy is performed in case of the following conditions:

  • Chronic cough (cough for more than 6 weeks)
  • Haemoptysis (coughing up blood)
  • Dyspnoea or difficulty in breathing
  • Airway blockage
  • Inhalation intoxicating gases
  • Need for a biopsy

Bronchoscopy is also helpful as a follow-up procedure after a scan in cases of tumour, infection or lung collapse. Bronchoscopy helps in:

  • Removal of mucus plug, fluid or foreign objects from the respiratory tract
  • Cancer treatment
  • Abscess drainage
  • Widening of narrowed or blocked airway

Bronchoscopy requires certain preparations:

  • Medications, such as blood thinners and warfarin, should be stopped several days before the procedure.
  • About four to eight hours of fasting is required before going for a bronchoscopy.
  • During the procedure, a gown needs to be worn, and articles, such as dentures, bridges, hearing aids and contact lenses need to be removed.
  • It is also recommended to have a family member or a friend alongside during and after the procedure for assistance.

Bronchoscopy involves the following steps:

  1. A local anaesthetic agent is sprayed into the nose and throat to numb the area. Sedatives or general anaesthesia may be used, particularly when a rigid bronchoscope is to be used.
  2. After the anaesthesia starts to show its effect, a flexible bronchoscope is inserted through the nose or mouth into the throat and then bronchi; the tube moves into lungs for having a good view of the airways.
  3. In certain cases, a stent is inserted to obtain tissue samples for a biopsy.
  4. Saline may be sprayed occasionally through airways, and the fluid is suctioned back and collected for evaluation.
  5. During bronchoscopy, in cancer cases, an ultrasound is performed to visualise the lymph nodes and tissue around the airway.
  6. The whole procedure usually takes 20-30 minutes.

Bronchoscopy is a relatively safe, painless and quick procedure. A person undergoing this procedure remains in the hospital for a few hours (until the effect of the anaesthesia wears off). Usually, breathing and blood pressure are evaluated regularly during these hours to check for complications.

It is safe to eat only after cough reflex has returned (which usually happens within 2 hours). Further, routine activities can be resumed after 24 hours. Sore throat and hoarseness of voice are common after the procedure, which can remain for 3-4 days.

Bronchoscopy results are available immediately; however, it may take 4-7 days for final reporting in cases of biopsy.

Normal findings of bronchoscopy indicate that no foreign body, fluids, abnormal cells, lymph nodes or blockages in the bronchi.

Abnormal findings include the presence of a foreign body, abnormal fluid, abnormal cells, enlarged lymph nodes or blockages, which could indicate:

  • Infection (bacterial, viral, fungal or parasitic)
  • Inflamed lung tissue
  • Cancer
  • Foreign body
  • Lung collapse
  • Narrowed bronchi or trachea
  • Rejection of a lung transplant

Diagnostic bronchoscopy is converted into therapeutic bronchoscopy when a foreign body or abnormal fluid collection is seen, which will help manage the situation.

This procedure carries a risk of breathing difficulty, infection, low blood oxygen levels, abnormal beating of heart (arrhythmia) and minor bleeding. Rarely, it can cause lung collapse or pneumothorax. These complications are required to be reported and need immediate medical attention.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. This information is purely from an educational perspective and is in no way a substitute for medical advice from a qualified doctor.

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References

  1. The Merck Manual of Diagnosis and Therapy [internet]. US; Bronchoscopy
  2. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; What is bronchoscopy?
  3. Spiro SG, et al. Bronchoscopy. In: Clinical Respiratory Medicine. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2012.
  4. Du Rand IA, et al. British Thoracic Society Guideline for diagnostic flexible bronchoscopy in adults. Thorax 2013;68:i1.