Bronchoscopy

What is bronchoscopy?

Bronchoscopy is a procedure that helps the healthcare provider look directly at the airways in the lungs using a thin, lighted tube (bronchoscope). The bronchoscope is put in the nose or mouth. It is moved down the throat and windpipe (trachea), and into the airways. A healthcare provider can then see the voice box (larynx), trachea, and large and medium-sized airways.

There are 2 types of bronchoscopes: flexible and rigid. Both types come in different widths.

A rigid bronchoscope is a straight tube. It’s only used to view the larger airways. It may be used within the bronchi to:

• Remove a large amount of secretions or blood

• Control bleeding

• Remove foreign objects

• Remove diseased tissue (lesions)

• Do procedures and other treatments

A flexible bronchoscope is used more often. Unlike the rigid scope, it can be moved down into the smaller airways (bronchioles). The flexible bronchoscope may be used to:

• Place a breathing tube in the airway to help give oxygen

• Suction out secretions

• Take tissue samples (biopsy)

• Put medicine into the lungs

Why might I need bronchoscopy?

A bronchoscopy may be done to diagnose and treat lung problems such as:

• Tumors or bronchial cancer

• Airway blockage (obstruction)

• Narrowed areas in airways (strictures)

• Inflammation and infections such as tuberculosis (TB), pneumonia, and fungal or parasitic lung infections

• Interstitial pulmonary disease

• Causes of persistent cough

• Causes of coughing up blood

• Spots seen on chest X-rays

• Vocal cord paralysis

Diagnostic procedures or treatments that are done with bronchoscopy include:

• Biopsy of tissue

• Collection of sputum

• Fluid put into the lungs and then removed (bronchoalveolar lavage or BAL) to diagnose lung disorders

• Removal of secretions, blood, mucus plugs, or growths (polyps) to clear airways

• Control of bleeding in the bronchi

• Removing foreign objects or other blockages

• Laser therapy or radiation treatment for bronchial tumors

• Placement of a small tube (stent) to keep an airway open (stent placement)

• Draining an area of pus (abscess)

Your healthcare provider may also have other reasons to advise a bronchoscopy.

What are the risks of bronchoscopy?

In most cases, the flexible bronchoscope is used, not the rigid bronchoscope. This is because the flexible type has less risk of damaging the tissue. And it provides better access to smaller areas of the lung tissue.

All procedures have some risks. The risks of this procedure may include:

• Bleeding

• Infection

• Hole in the airway (bronchial perforation)

• Irritation of the airways (bronchospasm)

• Irritation of the vocal cords (laryngospasm)

• Air in the space between the lung covering (pleural space) that causes the lung to collapse (pneumothorax)

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk about any concerns you have.

In some cases, a person may not be able to have a bronchoscopy. Reasons for this can include:

• Severe narrowing or blockage of the trachea (tracheal stenosis)

• High blood pressure in the lungs’ blood vessels (pulmonary hypertension)

• Severe coughing or gagging

• Low oxygen levels

• High risk of bleeding

If you have high levels of carbon dioxide in the blood (hypercapnia) or severe shortness of breath, you may need to be on a breathing machine before the procedure. This is done so oxygen can be sent right into your lungs while the bronchoscope is in place.

How do I get ready for bronchoscopy?

Give your healthcare provider a list of all of the medicines you take. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. You may need to stop certain medicines before the procedure. Follow any directions you're given for not eating or drinking before the procedure.

You will be asked to sign an informed consent document. This document explains the benefits and risks of the procedure. Make sure all of your questions are answered before you sign it.

If the procedure is being done on an outpatient basis, arrange to have someone drive you home.

What happens during bronchoscopy?

You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. A bronchoscopy can take 15 minutes to 1 hour. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, a bronchoscopy will follow this process:

1. Your healthcare provider may ask you to remove your clothes. If so, they will give you a hospital gown to wear. They may ask you to remove jewelry or other objects.

2. You will lie down on a procedure table with the head raised up slightly.

3. Your healthcare provider may put an IV (intravenous) into your arm or hand.

4. Your healthcare provider may give you antibiotics before and after the procedure.

5. You will be awake during the procedure. Your healthcare provider will give you medicine to help you relax (sedative). They will also give you a liquid medicine to numb your nose and throat. For a rigid bronchoscopy, they will give you general anesthesia. This is medicine that prevents pain and lets you sleep through the procedure.

6. Your healthcare provider may give you oxygen through a nasal tube or face mask. They will watch your heart rate, blood pressure, and breathing during the procedure.

7. Your provider will spray numbing medicine into the back of your throat. This is to prevent gagging as the bronchoscope is passed down your throat. The spray may have a bitter taste to it. Once the tube passes down your throat, the gagging feeling will go away.

8. You won’t be able to talk or swallow saliva during the procedure. Saliva will be suctioned from your mouth as needed.

9. Your provider will move the bronchoscope down your throat and into the airways. You may have some mild pain. Your airway will not be blocked. You can breathe around the bronchoscope. You will be given extra oxygen if needed.

10. As the bronchoscope is moved down, the lungs will be examined. Your provider may take tissue samples or mucus for testing. They may do other procedures as needed. This may include giving medicine or stopping bleeding.

11. When the exam and other procedures are done, the bronchoscope will be taken out.

What happens after bronchoscopy?

After the procedure, you will spend some time in a recovery room. You may be sleepy and confused when you wake up from general anesthesia or sedation. Your healthcare team will watch your vital signs, such as your heart rate and breathing.

A chest X-ray may be done right after the procedure. This is to make sure your lungs are OK. You may be told to gently cough up and spit your saliva into a basin. This is so a nurse can check your secretions for blood.

You may have some mild pain in your throat. You won't be allowed to eat or drink until your gag reflex has returned. You may notice some throat soreness and pain with swallowing for a few days. This is normal. Using throat lozenges or gargling may help.

If you had an outpatient procedure, you will go home when your healthcare provider says it’s OK. Someone will need to drive you home.

At home, you can go back to your normal diet and activities if instructed by your healthcare provider. You may need to limit any physical activity for a few days.

You may notice a low-grade fever. This is common.

Call your healthcare provider if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as advised by your provider

• Redness or swelling of the IV site

• Blood or other fluid leaking from the IV site

• Coughing up significant amounts of blood

• Chest pain

• Severe hoarseness

• Trouble breathing

Your healthcare provider may give you other instructions after the procedure.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure