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Bronchoscopy

By

Catherine Spader, RN

What is a bronchoscopy?

A bronchoscopy is a minimally invasive procedure used to diagnose and treat respiratory conditions. Bronchoscopy involves inserting a bronchoscope through your mouth or nose and passing it into your airways and lungs. A bronchoscope is a lighted, tube-like instrument with a camera for examining the inside of your airways. 

Bronchoscopy is only one method of diagnosing and treating lung-related diseases. Discuss all your options with your doctor to understand which choices are best for you.  

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Types of bronchoscopy

The types of bronchoscopy procedures include:

  • Flexible bronchoscopy involves passing a thin, flexible bronchoscope through your nose or mouth, down your throat, and into your airways. The bronchoscope has a light and small camera that allows your doctor to see and take pictures of your windpipe and airways.

  • Rigid bronchoscopy involves passing a wider and stiffer bronchoscope through the mouth. This larger bronchoscope can accommodate special instruments used for treatments. Treatments include removing a foreign body, inserting special ultrasound equipment, treating bleeding, and placing stents to keep the airway open.

Why is a bronchoscopy performed?

Your doctor may recommend a bronchoscopy to diagnose and treat certain conditions of the trachea (windpipe), bronchi, and lungs. 

A diagnostic bronchoscopy allows your doctor to examine the lungs and airways and take a biopsy. A biopsy involves removing tissue samples to test for cancer and other diseases. A diagnostic bronchoscopy can help diagnose the cause of the following conditions and situations:

  • Abnormal findings on a chest X-ray or CT

  • Atelectasis (lung collapse)

  • Cancer or tumors including lung or tracheal cancer

  • Chronic cough lasting several weeks

  • Interstitial lung disease (inflammation of deep lung tissues)

  • Lung abscess

  • Lung bleeding including coughing up blood

  • Swelling or injury of the vocal cords, trachea (windpipe), or other airways

A therapeutic bronchoscopy provides treatments. It allows your doctor to:

  • Insert an endotracheal tube into the trachea to permit mechanical ventilation

  • Place medication directly on a lung problem

  • Place a small tube or stent to hold the airway open

  • Remove a foreign object

  • Remove all or part of a tumor

  • Suction excessive secretions in the deep airways in the lungs

Who performs a bronchoscopy?

Pulmonologists and thoracic surgeons perform outpatient bronchoscopies.

Pulmonologists are internists or pediatricians with specialized training in treating diseases and conditions of the chest, such as pneumonia, asthma, tuberculosis, emphysema, or complicated chest infections. Thoracic surgeons specialize in surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus.

How is a bronchoscopy performed?

Your bronchoscopy will be performed in a special bronchoscopy room or lab in a clinic or hospital. It is also performed in surgery and in the intensive care unit (ICU) for in seriously ill patients.

The procedure takes about four hours, including preparation and recovery time. It generally involves these steps:

  1. You will undress and put on a patient gown. Your care team will provide sheets or blankets for modesty or warmth.

  2. Your care team will position you on a special table or bed and start an intravenous (IV) line.

  3. You will receive anesthesia and medication to make you comfortable during the procedure. For flexible bronchoscopy, this is generally a local anesthetic, such as lidocaine spray, to numb your mouth and throat. You will also have oral or IV sedation to make you relaxed and sleepy. For rigid bronchoscopy, you will likely have general anesthesia to make you completely unaware of the procedure.  
  4. Your doctor will insert the bronchoscope through your nose or mouth and pass it down your throat into your trachea (windpipe) and lungs.

  5. Your doctor will take pictures of your airways. Your doctor might insert tiny instruments through the bronchoscope to take a biopsy and perform a treatment. Treatments include removal of a tumor or foreign object and washing out the lungs with a special saline solution.

  6. Your doctor will remove the bronchoscope.

  7. Your care team may take a chest X-ray to check for lung problems or damage due to the procedure.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You will be unaware and not feel any pain during your bronchoscopy if you have general anesthesia. 

If you have local anesthesia and sedation, you may gag a little as the bronchoscope passes through the back of your mouth. Once it enters your throat, that feeling should go away. Tell your doctor if any discomfort does not pass quickly. 

You may feel hoarse and have a sore throat after bronchoscopy. You doctor will treat your pain or discomfort. Tell your doctor or care team if treatments are not helping or your discomfort is getting worse because it may be a sign of a complication.

What are the risks and potential complications of a bronchoscopy?

A bronchoscopy is generally safe, with minor side effects and a low risk of complications. Side effects include feeling hoarse and having a sore throat after the procedure. These are temporary and should improve in a day or two. 

Bronchoscopy does involve some risks and possible complications. Complications may become serious in rare cases. Complications can develop during the procedure or recovery.

Potential complications of bronchoscopy

Complications of bronchoscopy include:

  • Adverse reaction or problems related to anesthesia, sedation or medications, such as an allergic reaction and problems with breathing

  • Bleeding

  • Infection

  • Pneumonia

  • Pneumothorax (collapsed lung)

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and: 

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during your recovery

  • Notifying your doctor right away of any concerns, such as ongoing sore throat and hoarseness, coughing up blood, fever, or increase in pain

  • Taking or stopping your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my bronchoscopy?

You are an important member of your own healthcare team. The steps you take before procedure bronchoscopy can improve your comfort and outcome and help get the most accurate test results. 

You can prepare for a bronchoscopy by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Completely following all preoperative instructions. This generally includes not eating or drinking anything for six to 12 hours before the procedure.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Having a bronchoscopy can be stressful. It is common for patients to forget to ask questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a bronchoscopy and between appointments.

It is also a good idea to bring a list of questions to your appointments. Common questions include:

  • Why do I need a bronchoscopy? Are there any other options for diagnosing or treating my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • How should I take my medications?

  • How will you treat my discomfort?

  • When and how will I get my test results?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my bronchoscopy?

Knowing what to expect after a bronchoscopy can help you get back to your everyday life as soon as possible.

How will I feel after the bronchoscopy?