What Is Bronchoscopy?

What to expect when undergoing this test

illustration of the lungs and bronchi
What should you know about your bronchoscopy procedure?. Istockphoto.com/Stock Photo©yodiyim

A bronchoscopy is an endoscopic medical procedure for looking inside the airways (bronchi) and the lungs. It involves inserting a bronchoscopea narrow tube that has a light and a camera on one end—through the nose or mouth and guiding it down through the trachea (windpipe) in order to get an internal view of the respiratory system. It may be done to diagnose a disease or condition such as lung cancer or infection, or to treat a medical problem such as a foreign object that's lodged in the airways.

Purpose of the Test

There are two main reasons a person might need a bronchoscopy:

Evaluation

Your doctor may opt to perform a bronchoscopy to evaluate symptoms and other indications that something may be wrong with the lungs or airways. Examples include:

  • A chronic cough—one that has lasted for more than three months with no obvious cause
  • Hemoptysis (coughing up blood)
  • Shortness of breath or low oxygen levels
  • A suspicion there may be something lodged in your airways
  • An imaging test that showed a tumor or growth on a lung, scarring or other changes to the lung tissue, or the collapse of an area of a lung
  • Symptoms of infection in the lungs or bronchi that can't be diagnosed another way or require a special type of evaluation
  • Signs of rejection after a lung transplant
  • Inhalation of a toxic gas or chemical

A bronchoscopy also can be used to take a biopsy of abnormal lung or airway tissue and to visualize tumors within the lungs that do not extend into the bronchi using a technique known as endobronchial ultrasound (EBUS). In this procedure, a tumor deep in the airways may be visualized with ultrasound and biopsied during a bronchoscopy (an ultrasound-guided needle biopsy).

In addition to techniques designed to look deeper than the airways during a bronchoscopy, there are also several new technologies used to diagnose early lung cancers. These include autofluorescence bronchoscopy, narrowband imagery, and high magnification video bronchoscopy.

Treatment

By providing both access and a direct view of the inside of the airways and lungs, a bronchoscopy can allow a doctor to perform all sorts of treatments, such as:

  • Removing fluid or mucus from airways
  • Removing a foreign object from airways
  • Widening (dilating) an airway that is blocked or narrowed
  • Draining an abscess
  • Washing out an airway

Bronchoscopy can also be used as part of certain treatments for lung cancer that is in or near the large airways. It might be used to assist with a procedure called brachytherapy, for instance, in which radiation is delivered directly to a tumor through the bronchoscope.

There are two types of bronchoscopy. The most common uses a flexible bronchoscope and requires on local anesthesia and a light sedative. Less often a rigid bronchoscope, which is thicker than a flexible one and typically made of metal, is necessary. In that case, a patient must be under general anesthesia in an operating room.

Which one your doctor opts for will depend on the purpose of the test and your overall condition.

Risks and Contraindications

Most people tolerate both types of bronchoscopy quite well. There are some potential risks, though they are not common, including:

  • Spasms in the airway such as laryngospasm (spasm of the larynx) or bronchospasm (spasm of the bronchi)
  • Cardiac complications such as an abnormal heart rhythm or heart attack in people with existing heart disease
  • Low blood oxygen
  • Breathing difficulties
  • Pneumothorax (a collapsed lung): This can happen if the lung is punctured during the procedure, allowing air to collect in the space around the lungs. If small, your doctor may simply follow it with a chest X-ray. If it is large, a chest tube may need to be placed to remove the air and you may need to be admitted to the hospital.

Because general anesthesia is required, there are a few additional risks associated with rigid bronchoscopies, such as:

  • Muscle pain
  • Blood pressure changes
  • Slowed heart rate
  • Nausea and vomiting

There are some conditions and situations that make having a bronchoscopy (of either type) inadvisable or impossible. The most common ones are:

  • An untreatable life-threatening heart arrhythmia
  • The inability to adequately oxygenate a patient during the procedure
  • Acute respiratory failure with hypercapnia, a condition in which there's an excess of carbon dioxide in the blood (unless the patient is intubated and ventilated)
  • A blockage in the trachea (from a tumor or growth, for example)
  • Uncooperative patient
  • A recent heart attack
  • A disorder that affects the ability of blood to clot (coagulopathy)

There are a few people who can safely have a bronchoscopy for viewing purposes, but for whom caution should be taken if doing a biopsy. These are patients who have:

  • Uremia, a symptom associated with advanced kidney disease
  • A superior vena cava obstruction (a rare condition in which the large vein that moves blood from the upper half of the body to the heart is blocked, often by a tumor)
  • Pulmonary hypertension, because of increased risk of bleeding

Inspection of the airways is safe in these patients, however.

Before the Test

Bronchoscopy is a common test in pulmonology. That said, it might be all new to you. Knowing a little more about it can help you enter your test confidently.

Timing

The amount of time it takes to perform a bronchoscopy varies depending on the reason it's being done and whether any other procedures will be done at the same time, such as a biopsy. Typically, though, a bronchoscopy itself takes between 30 minutes and 60 minutes. With preparation and recovery time, the entire process (from when you check in until you've recovered and are free to leave) usually takes about four hours. Ask your doctor for an estimate of how long the procedure is likely to last in your case.

Location

Bronchoscopy is done in a hospital. A flexible bronchoscopy may be done in a special procedure suite. A rigid bronchoscopy is performed in an operating room. In some cases, the procedure may take place in an intensive care unit of a hospital.

What to Wear

Dress comfortably in clothing that can be easily removed and put back on, as you will be asked to change into a hospital gown. It's always a good idea to leave jewelry and other non-essential personal items at home so you don't risk losing them. You also may need to remove dentures, bridges, hearing aids, contact lenses, or eyeglasses.

Food and Drink

You should not eat or drink anything for six to 12 hours beforehand.

In advance of the procedure, you may also need to take a break from certain medications or supplements that could cause problems during the bronchoscopy or interact with anesthesia or other drugs you may be given. Be upfront with your doctor about everything you take and follow her advice accordingly.

Medications that typically should be stopped in preparation for surgery include any that can interfere with blood coagulation—in other words, that cause blood to thin. Common ones are:

  • Coumadin (warfarin)
  • Aspirin (prescription and over-the-counter)
  • Non-steroidal anti-inflammatory drugs (NSAIDS), such as Advil (ibuprofen) and Tylenol (acetaminophen), both prescription and OTC
  • Lovernox (enoxaparin)
  • Ticlid (ticlopidine)
  • Persantine (diphyridamole)
  • Vitamin E
  • Garlic
  • Ginger
  • Ginkgo biloba

Cost and Health Insurance

Bronchoscopy typically is covered by health insurance, although there may be a co-pay or co-insurance due the day of the procedure, depending on your plan. Double-check with your insurance company to make sure you know what to expect in terms of your financial responsibilities so that you're prepared.

If you will be paying for the procedure, a bronchoscopy can cost around $3,000, depending on your location.

What to Bring

Your doctor will instruct you as to what you should bring. This likely will include your health insurance card and personal identification (typically a driver's license). Ask if there will be much downtime before the procedure; if so, you might want to bring a book or some other activity to keep yourself occupied. You will also need to bring along someone who can drive you home.

Other Considerations

Make sure you have a reliable ride to and from the hospital on the day of the procedure. (In rare cases, a patient may need to stay in the hospital overnight.)

Be prepared to rest the day after. Let your employer know you'll need to take the day off, arrange for childcare or other help around the house, hire a dog walker, or ask a friend or family member to be around to help with other daily tasks, if possible.

During the Test

You will interact with several people—a doctor, nurse, and perhaps an anesthesiologist—during your bronchoscopy. The procedure itself can vary slightly depending in large part on whether you'll be having a flexible or rigid bronchoscopy and if you'll be having a biopsy or some sort of therapy at the same time. In general, here's what you can expect.

Pre-Test

When you arrive at the hospital, there may be paperwork to complete. You'll then be asked to change into a hospital gown and perhaps to remove your jewelry, glasses, hearing aids, or other items. You'll then be escorted to a table or hospital bed and asked to lie down.

The physician performing the procedure—usually a lung specialist (pulmonologist) or thoracic surgeon—will come by to review the details of the procedure and its risks, and have you sign a consent form. If you are having a rigid bronchoscopy, the anesthesiologist will talk to you about the general anesthesia you will receive before you go into the operating room.

Once there, a nurse will place an IV (intravenous) line into your arm. She will fit you with monitors so that your blood pressure and heart rate can be checked throughout the procedure and will connect you to a device called a pulse oximeter so that your blood oxygen levels can be monitored. You may be fitted with a nasal tube or oxygen mask so that you can receive oxygen during the procedure.

For a flexible bronchoscopy, you will undergo what is called conscious sedation: You'll be given a medication to make you sleepy (twilight sleep) and one to help dry secretions in your lungs. A local anesthetic will be used to relax and numb your throat or nose before the bronchoscope is inserted. This may have a bad taste and cause you to cough temporarily, but both ill effects will subside quickly. This is all to prevent you from gagging.

Throughout the Test

If you are under general anesthesia for a rigid bronchoscopy, you won't be aware of any sensation or activity during your procedure. If you're under conscious sedation for a flexible bronchoscopy, however, there are times you may be faintly aware of what's going on.

First, the doctor performing the test will insert the tip of the bronchoscope where the camera is located into your throat or your nose and then guide it down the back of your throat, through your vocal cords, and into your airways. As the tube moves through your windpipe, you may feel a slight sensation of pressure or tugging. You may even feel you aren't able to breathe, but there is no risk that this will happen. You'll actually be able to breathe around the tube, but won't be able to talk or swallow. Saliva will be suctioned from your mouth as it accumulates.

What the doctor does once the bronchoscope is in will depend on the extent of the procedure. He may start with a procedure called lavage in which saline solution is sent through the tube and into the airways to wash them out and make it easier to collect samples of lung cells, fluids, and other materials in the air sacs.

If the goal is simply to view the inside of the airways—to find the source of a persistent cough, for instance—the doctor may manipulate the camera in order to get a good look at areas of concern and then remove the tube once that's been accomplished.

If the purpose of the procedure is to take samples of tissue or fluid, to remove a foreign object, place a stent, or administer radiation, any devices required to do these things will be threaded through the tube. While this is happening, and depending on your level of sedation, the doctor may ask you if you're feeling pain in your chest, back, or shoulders. He also may have you hold your breath for short periods of time.

Sometimes a doctor will perform an endobronchial ultrasound (EBUS) during a bronchoscopy to get additional information about the health of your lungs. Often this is done to check the lymph nodes in the chest of someone who has lung cancer in order to determine what type of treatment is required.

Once all procedures associated with the bronchoscopy are complete, the tube is gently withdrawn. If you're receiving anesthesia, it will be stopped. You will be taken to a recovery room.

Post-Test

What happens after your bronchoscopy will depend in part on what type you had.

After a flexible bronchoscopy, you may continue to feel drowsy as the effects of sedation wear off. You also may have a headache or feel nauseous. You will be monitored until you're alert and recovered enough to go home. A pulse oximeter will be clipped onto your finger to measure the oxygen levels in your blood. Your blood pressure will be checked with arm cuff every 15 minutes or so.

If you have general anesthesia for a rigid bronchoscopy, you will wake up in the recovery room. When you do, you'll feel tired, groggy, and perhaps sick to your stomach, and may have a dry mouth and sore throat. You may also feel cold and shivery until the effect of the anesthesia wears off. This can take several hours; don't be shy about asking for extra blankets. A nurse will monitor you during this time. If you're really nauseous or start vomiting, you may be given medication to soothe these side effects of the anesthesia.

After either type of bronchoscopy, an X-ray of your chest may be taken to make sure there was no damage to your lungs during the procedure. You also may be asked to gently cough up and spit out some saliva to be examined for traces of blood.

After the Test

Whichever type of bronchoscopy you have, you will need to be driven home afterward. If you had general anesthesia, you may continue to feel the effects of it for 24 hours or so. For that reason, you'll likely be advised to not drive or make important decisions until a full day after your procedure. Otherwise, you should be able to resume your normal diet and activities unless your doctor gives you other instructions.

Managing Side Effects

Most of the immediate side effects of bronchoscopy and general anesthesia, if you have it, will resolve before you're allowed to leave the hospital. Two that are related and likely to linger for a few days are a sore throat and hoarseness. Your throat is bound to be tender after having a tube of any size threaded through it. You may even experience mild bleeding at the site of a biopsy, if taken.

For relief, you can turn to the same remedies you might rely on to soothe a sore throat caused by a cold or flu, such as over-the-counter numbing sprays, gargles, and throat lozenges. You also may want to stick with soft foods that go down easily, such as yogurt and ice cream (the cold will help number your throat as well), and avoid spicy, citrus, and other potentially irritating foods.

If your throat continues to hurt and you're hoarse for more than five to seven days after your bronchoscopy, let your doctor know. You should also let your doctor know if you develop any of the following rare side effects of bronchoscopy:

  • A fever of 100.4 degrees or higher (or as advised by your doctor)
  • Redness or swelling where the IV line was inserted, which can indicate infection
  • Blood or another fluid leaking from the IV site
  • Coughing up significant amounts of blood (more than a few quarter-sized clots or teaspoons)
  • Chest pain
  • Trouble breathing

Interpreting the Results

Following your bronchoscopy, your doctor will schedule an appointment to discuss your results. If a biopsy was taken during your procedure, it will take a few days for the lab to evaluate the tissue and send results to your doctor.

If the results of your test are normal, it means that only normal cells and fluids were found, and there was no evidence of a foreign substance or blockage.

Abnormal results could include any of the following:

  • An infection caused by bacteria, a virus, fungi, or a parasite
  • Tuberculosis
  • Lung damage associated with an allergic-type reaction
  • Disorders in which tissues deep in the lungs become inflamed and damaged as a result of an immune system response, such as sarcoidosis or rheumatoid arthritis
  • Lung damage related to allergic-type reactions
  • Cancer in the lungs or in the area between the lungs
  • Narrowing (stenosis) of the trachea or bronchi
  • Rejection of a transplanted lung

Follow-Up

You may need further tests if an abnormality is found during your bronchoscopy. The type of test will depend on the nature of the finding, of course. If it turns out you have an infection or other treatable condition, your doctor will prescribe the appropriate medication or go over your options for treatment if there are any.

A Word From Verywell

Given its versatility for both diagnosis and treatment of myriad medical conditions, bronchoscopy is clearly an important and useful procedure. It also is very safe, takes only a few hours, causes minimal side effects, and requires little recovery time.

While the prospect of any invasive procedure is bound to create some anxiety—especially if it's being done based on a suspicion there may be something seriously wrong with your lungs or airways—understanding that the bronchoscopy itself won't hurt or put you in danger should help to ease your mind to some extent and allow you to focus on what you need to in regards to your condition.

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