What is a Bronchoscopy?

Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy, your doctor will examine your throat, larynx, trachea, and lower airways.

Bronchoscopy may be done to diagnose problems with the airway or to remove an object or growth from the airway.

There are two types of bronchoscopy.

• A flexible bronchoscope uses a long, thin, lighted tube to look at your airway. The flexible bronchoscope is used more often than the rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and offers a better view of the smaller airways. It also allows the doctor to remove small samples of tissue (biopsy).
• A rigid bronchoscope is usually done with general anesthesia and uses a straight, hollow metal tube. It is used: 
  • When there is bleeding in the airway that could block the flexible scope's view.
  • To remove large tissue samples for biopsy.
  • To clear the airway of objects (such as a piece of food) that cannot be removed using a flexible bronchoscope.
  • Special procedures, such as widening (dilating) the airway or destroying a growth using a laser, are usually done with a rigid bronchoscope.

Why Is Bronchoscopy Done?

Bronchoscopy may be used to:

• Identify the cause of airway problems, such as bleeding, difficulty breathing, or inflammation from other lung diseases. 
• Take tissue samples when other tests, such as a chest X-ray or CT scan, show areas of the lung that may have problems. 
• Diagnose lung diseases by collecting tissue or mucus (sputum) samples for biopsy.
• Diagnose and determine the extent of lung cancer.
• Remove objects blocking the airway.
• Evaluate and treat growths in the airway.
• Control bleeding (hemoptysis).

How Do I Prepare for Bronchoscopy?

You will be asked to sign a consent form before a bronchoscopy. Talk to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will indicate. Before you have a bronchoscopy, tell your doctor if you:

• Are taking any medications
• Are allergic to any medications, including anesthetics.
• Have had bleeding problems or take blood-thinners, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
• Are or might be pregnant.

Your doctor may order other tests before your bronchoscopy, such as a complete blood count (CBC), bleeding factors, arterial blood gas (ABG), or pulmonary function tests (PFT).

Do not eat or drink for at least 8 to 10 hours before the procedure.

Arrange to have someone drive you home after the procedure.

How Is the Bronchoscopy Done?

You may be given some medications before the procedure to dry up the secretions in your mouth and airways.

You may be asked to remove dentures, eyeglasses or contact lenses, hearing aids, wigs, makeup, and jewelry before the biopsy. You will empty your bladder before the biopsy. You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy.

The procedure is done by a pulmonologist and an assistant. Your heart rate, blood pressure, and oxygen level will be checked during the procedure. 

A chest X-ray may be done before and after the bronchoscopy.

• Flexible bronchoscopy

• During this procedure, you will lie on your back on a table with your shoulders and neck supported by a pillow, or you will recline in a chair that resembles a dentist's chair. Sometimes the procedure is done while you are sitting upright.
• You will be given a sedative to help you relax. You may have an intravenous line (IV) placed in a vein. You will remain awake but sleepy during the procedure.
• Before the procedure, your doctor usually sprays a local anesthetic into your nose and mouth. This numbs your throat and reduces your gag reflex during the procedure. If the bronchoscope is to be inserted through your nose, your doctor may also place an anesthetic ointment in your nose to numb your nasal passages.
• Your doctor gently and slowly inserts the thin bronchoscope through your mouth (or nose) and advances it to the vocal cords. Then more anesthetic is sprayed through the bronchoscope to numb the vocal cords. Since you are awake, you may be asked to make a high-pitched sound so the scope can pass your vocal cords. It is important to avoid trying to talk while the bronchoscope is in your airway.
• A large X-ray machine (fluoroscope) may be placed above you to transmit an X-ray picture to a TV monitor. The picture on the monitor helps your doctor see clearly while the bronchoscope is moved through your airway. The bronchoscope is then moved down your larger breathing tubes (bronchi) to examine the lower airways.
• If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or brush will be used through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab to be studied.
• Finally, a small biopsy needle may be used to remove a sample of lung tissue. This is called a transbronchial biopsy.

• Rigid bronchoscopy
  • This procedure is usually performed under general anesthesia. You will lie on your back on a table with your shoulders and neck supported by a pillow.
  • You will be given a sedative to help you relax. You will have an intravenous line (IV) placed in a vein. A tube (endotracheal) will be placed in your windpipe (trachea) and a machine will help you breathe.
  • Once you are asleep, your head will be carefully positioned with your neck extended. Your doctor then slowly and gently inserts the bronchoscope through your mouth and into your windpipe.
  • If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or a brush will be inserted through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab for biopsy.

Bronchoscopy by either procedure usually takes between 30 to 60 minutes. You will be in recovery for 2 to 3 hours after the procedure. Following the procedure:

Do not eat or drink anything for about 2 hours, until you are able to swallow without choking. After that, you may resume your normal diet, starting with sips of water.

Spit out your saliva until you are able to swallow without choking.
Do not smoke for at least 24 hours.
If a biopsy was done, do not clear your throat or cough vigorously for several hours.

How It Feels

If you have general anesthesia, you will feel nothing during the procedure. Oxygen is usually given through a small tube placed in your nose if you are awake during the procedure.

You may be able to feel pressure in your airway as the bronchoscope is moved from place to place. You may gag or cough during bronchoscopy. Your airway will not be blocked but if you feel discomfort, let your doctor know.

After the procedure, you may feel tired for a day or so and have general muscle aches. If a local anesthetic is used, it usually tastes bitter. Your mouth may feel very dry for several hours after the procedure. You may also have a sore throat and some hoarseness for a few days. Sucking on throat lozenges or gargling with warm salt water may help soothe your sore throat.

If a biopsy was taken, it is normal to spit up a small amount of blood after the procedure.

What are the Risks of Bronchoscopy?

Bronchoscopy is generally a safe procedure. Although complications are rare, your doctor will discuss any risks with you. Complications that may occur include:

• Spasms of the bronchial tubes, which can impair breathing.
• Irregular heart rhythms (arrhythmias).
• Infections, such as pneumonia. These can usually can be treated with antibiotics.
• Ongoing hoarseness.
• Bubbles under the skin that crackle and pop when pressed.
• If a biopsy was done during bronchoscopy, complications that may occur include:
  • A tear in the lung from the needle used to collect a tissue sample. This will allow air to flow into the pleural space, producing a partial collapse of the lung (pneumothorax).
  • Bleeding caused by the needle used to collect the tissue.
  • An infection from the biopsy procedure.
  • If you receive general anesthesia, there is a small chance of death from complications associated with general anesthesia. However, this is very rare.

After the procedure, Call your doctor immediately if you:

• Cough up more than 2 Tbsp(30 mL) of blood.
• Have difficulty breathing.
• Have a fever for more than 24 hours. A mild fever [under 100 °F(38 °C)] may be present right after the procedure, but this is not a concern.

Your doctor may discuss your results with you soon after the procedure. Test results on any biopsy samples are usually available in 2 to 4 days.

What Affects the Test ?

Factors that can interfere with your procedure or the accuracy of the results include:

• A problem that limits your ability to extend your neck.
• A biopsy sample that is too small for a diagnosis.
• Also, a needle biopsy collects tissue from such a small area, so there is a chance that a cancer may be missed.