A bronchoscopy is a test where a doctor looks into your lungs with a thin, plastic camera tube.
This photo shows a bronchoscope:
Håkon Olav Leira (Own work) via Wikimedia CommonsBy Håkon Olav Leira (Own work) via Wikimedia Commons
A fibre-optic bronchoscope is the device usually used. This is a thin, flexible, telescope (shown in the diagram). It is about as thin as a pencil. You are usually awake during a bronchoscopy, but usually are sedated and made very sleepy. It is not painful.
The bronchoscope is passed through your nose or mouth, down the back of your throat, into your windpipe (trachea), and down into your bronchi. The fibre-optics allow light to shine around bends in the bronchoscope and so the doctor can see clearly inside your airways.
A rigid bronchoscope (not shown in diagram) is used much less often. It is like a thin, straight telescope. It may be needed for some procedures and in children. It requires a general anaesthetic. (A fibre-optic bronchoscopy only requires sedation.)
Both types of bronchoscope have a side channel down which thin instruments can pass. For example, a thin grabbing instrument can pass down to take a small sample (biopsy) from the inside lining of an airway, or from structures next to the airways.
There are various reasons for having a bronchoscopy. For example, to help make a diagnosis if you have a persistent cough or cough up blood and the cause is not clear. If you have a shadow on a chest X-ray or the doctor sees a growth or a strange-looking area in a bronchus, the doctor may take a small sample (a biopsy) during a bronchoscopy. The sample is then looked at under the microscope to help decide whether problems such as inflammation, infection or cancer might be responsible for your symptoms. Bronchial lavage (described below) is also sometimes done during a bronchoscopy to help diagnose certain lung conditions.
As mentioned, thin instruments can be passed down the side channel of a bronchoscope. Different instruments can do different things - for example:
- To remove a small object (such as an inhaled peanut) that has been lodged in an airway.
- To insert a small tube called a stent to open a blocked airway.
- To remove a growth that is blocking an airway.
- To take a small biopsy of a growth to see what it is.
This is usually done as an outpatient or day case. The doctor will numb the inside of your nose and the back of your throat by spraying on some local anaesthetic. This may taste a bit unpleasant. Also, you will normally be given a sedative to help you to relax. This is usually given by an injection into a vein in the back of your hand or your arm. The sedative can make you drowsy but it is not a general anaesthetic and does not make you go to sleep. However, you are unlikely to remember anything about the bronchoscopy if you have a sedative.
You may be connected to a monitor to check your heart rate and blood pressure during the procedure. A device called a pulse oximeter may 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. You may have soft plastic tubes placed just inside your nostrils to give you oxygen during the procedure.
The doctor will insert the tip of the bronchoscope into one of your nostrils and then gently guide it round the back of your throat into your windpipe (trachea). (It is sometimes passed via your mouth rather than via your nose if you have narrow nasal passages.) The bronchoscope may make you cough.
The doctor looks down the bronchoscope and inspects the lining of your trachea and main bronchi (the main airways). Bronchoscopes transmit pictures through a camera attachment on to a TV monitor for the doctor to look at.
The doctor may take one or more samples (biopsies) of parts of the inside lining of the airways - depending on why the test is done and what they see. This is painless. The biopsy samples are sent to the laboratory for testing and to be looked at under the microscope.
Sometimes bronchial lavage is done. This is a procedure where some fluid is squirted into a section of the lung and then syringed back. The fluid is then examined in the laboratory to look for abnormal cells and other particles that may be present in certain diseases.
The bronchoscope is then gently pulled out. Sometimes other procedures are done, as described earlier.
The bronchoscopy itself usually takes about 20-30 minutes. However, you should allow at least two hours for the whole appointment, to prepare, give time for the sedative to work, for the bronchoscopy itself and to recover.
Bronchoscopy using a rigid bronchoscopy
This requires a general anaesthetic, similar to that for minor operations. So, after receiving the anaesthetic, the next thing you know is when you wake up in a recovery room.
You may be advised not to take any medicines that affect blood clotting, such as aspirin and warfarin, for one week before the bronchoscopy. (You will need to discuss your medication with your doctor if you take such medicines for other conditions.)
In addition to this, you should receive instructions from the hospital before the test. These usually include:
- That you should not eat or drink for several hours hours before the bronchoscopy. (Small sips of water may be allowed up to two hours before the test.)
- That you will need somebody to accompany you home, as you will be drowsy with the sedative.
If you have a sedative, you may take an hour or so before you are ready to go home after the bronchoscopy is finished. The sedative will normally make you feel quite pleasant and relaxed. However, you should not drive, operate machinery or drink alcohol for 24 hours after having 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 somebody to accompany you home and to stay with you for 24 hours until the effects have fully worn off. Most people feel able to resume normal activities after 24 hours.
The doctor may tell you what they saw before you leave. However, if you have had a sedative you may not remember afterwards what they said. Therefore, you may wish to have a relative or close friend with you who may be able to remember what was said. The result from any sample (biopsy) may take a few days or weeks to come back.
Most are done without any problem. Your nose and throat may be a little sore for a day or so afterwards. You may feel tired or sleepy for several hours, caused by the sedative. There is a slightly increased risk of developing a throat or chest infection following a bronchoscopy.
If you had a biopsy taken, you may cough up a little blood a few times in the following day or so. Rarely, a bronchoscopy can cause damage to the lung. This is more likely to occur if a specialised sample (biopsy) of lung tissue is taken. Serious complications from a bronchoscopy are extremely rare.
A bronchoscopy is a test that allows your doctor to examine your airways. The procedure uses one of two types of instruments known as bronchoscopes:
- a flexible bronchoscope
- a rigid bronchoscope
The flexible type is more common and can be used in an office setting after administering relaxing medication. The rigid type is used if you have bleeding in your lungs or a large object is obstructing your airways. A rigid bronchoscopy is performed in a hospital setting under anesthesia.
During a bronchoscopy, your doctor will thread the bronchoscope through your nose or mouth and down your throat to reach your lungs. The bronchoscope has a light source and a camera on the end. Most bronchoscopes are compatible with color video, which helps your doctor document their findings.
Using the bronchoscope, your doctor can view all the structures that make up your respiratory system. These include your larynx, your trachea, and the smaller airways of your lungs, which are called the bronchi and bronchioles.
Taking a look through the bronchoscope can help your doctor diagnose and treat any lung-related issues you’re experiencing. Your doctor may also collect biopsies of airway secretions or tissues to help diagnose lung and airway conditions.
Diagnosis
A bronchoscopy can be used to diagnose:
- a lung disease
- a tumor
- a chronic cough
- an infection
The procedure can also be used to detect the source of pulmonary bleeding or identify foreign bodies in young children.
Your doctor may order a bronchoscopy if you have an abnormal chest X-ray or CT scan that shows evidence of an infection, a tumor, or a collapsed lung.
Treatment
The procedure is also sometimes used as a treatment tool.
A bronchoscopy can allow your doctor to deliver medication to your lungs or remove an object that’s caught in your airways, such as a piece of food. The procedure can also be used to administer laser treatment for certain small tumors.
If needed, bronchoscopy can be used to place small stents in the airways to keep them open.
Bronchoscopy is safe for most people. However, like all other medical procedures, it does come with some risks, such as:
- hoarseness
- bleeding, especially if a biopsy is done
- infection
- trouble breathing
- a low blood oxygen level during the test
Contact your doctor if you:
- have a fever
- cough up blood
- have trouble breathing
These symptoms can indicate a complication that requires medical attention, such as an infection.
Topical anesthesia used during bronchoscopy can have rare complications such as voice box or airway spasms, seizures, or cardiac arrhythmias (abnormal heart rhythms).
Very rare but potentially life threatening risks of the procedure include heart attack and lung collapse.
A collapsed lung can be due to a pneumothorax, or increased pressure on your lung due to the escape of air into the lining of your lung. This results from a puncture of the lung during the procedure and is more common with a rigid bronchoscope than with a flexible fiber-optic scope.
If air collects around your lung during the procedure, your doctor can use a chest tube to remove the collected air.
Who shouldn’t get a bronchoscopy?
Some people cannot undergo a bronchoscopy. Your doctor may not recommend the procedure if you have:
- tracheal stenosis (severe narrowing or blockage of the trachea)
- pulmonary hypertension (high blood pressure in the blood vessels of the lungs)
- recently had heart attack
- certain types of cardiac arrhythmias
- an untreatable bleeding disorder
- severe coughing or gagging
- low oxygen levels
In addition, your doctor may put you on a breathing machine before the procedure if you have hypercapnia (high levels of carbon dioxide in your blood) or severe shortness of breath. This is to ensure that your lungs are getting oxygen during the bronchoscopy.
A local anesthetic spray is applied to your nose and throat during a bronchoscopy. You’ll probably get a sedative to help you relax. This means you’ll be awake but drowsy during the procedure. Oxygen is usually given during a bronchoscopy. General anesthesia is rarely needed.
You’ll need to avoid eating or drinking anything for 6 to 12 hours before the bronchoscopy. Be sure to review a list of all medications you take, including prescriptions, over the counter, vitamins, and herbal supplements with your doctor. Before the procedure, you may need to need to stop taking:
- aspirin (such as Bayer)
- ibuprofen (such as Advil)
- warfarin
- other blood thinners
Bring someone with you to your appointment to drive you home afterward, or arrange for transportation.
Once you’re relaxed, the procedure will begin, going through the following steps:
1. Your doctor will insert the bronchoscope into your nose.
2. Your doctor will navigate the instrument from your nose down to your throat until it reaches your bronchi. The bronchi are the airways in your lungs.
3. Your doctor may have attached brushes or needles to the bronchoscope. If so, at this point, they will use those to collect tissue samples from your lungs. These samples can help your doctor diagnose any lung conditions you may have.
4. Your doctor may also use a process called bronchial washing to collect cells. This involves spraying a saline solution over the surface of your airways. The cells that are washed off the surface are then collected and looked at under a microscope
5. Depending on your specific condition, your doctor may find one or more of the following:
- blood
- mucus
- an infection
- swelling
- a blockage
- a tumor
6. If your airways are blocked, you might need a stent to keep them open. A stent is a small tube that can be placed into your bronchi with the bronchoscope.
7. When your doctor is finished examining your lungs, they’ll remove the bronchoscope.
Types of imaging used in a bronchoscopy
Advanced forms of imaging are sometimes used to conduct a bronchoscopy. Advanced techniques can provide a more detailed picture of the inside of your lungs:
- During a virtual bronchoscopy, your doctor uses CT scans to see your airways in more detail.
- During an endobronchial ultrasound, your doctor uses an ultrasound probe attached to a bronchoscope to see your airways.
- During a fluorescence bronchoscopy, your doctor uses a fluorescent light attached to the bronchoscope to see the inside of your lungs.
A bronchoscopy is relatively quick, lasting 30 to 45 minutes. Because you’ll be sedated, you’ll rest at the hospital for a couple of hours until you feel more awake and the numbness in your throat wears off. Your breathing and vital signs, including your blood pressure, heart rate, and oxygen levels, will be monitored during your recovery.
You won’t be able to eat or drink anything until your throat is no longer numb. This can take 1 to 2 hours. Your throat might feel sore or scratchy for a couple of days, and you might be hoarse. This is normal. It usually doesn’t last long and goes away without medication or treatment.