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 bronchoscope—a 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 condition such as lung cancer or infection, or to treat a medical problem such as a foreign object that's lodged in the airways.

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.

If you're having either type of bronchoscopy, here's what you need to know about the most common reasons this test is done, any risks or complications associated with it, and what you'll experience before, during, and after the procedure. Having this information ahead of time should help you to feel as comfortable as possible about going in for a bronchoscopy to examine your airways and lungs.

Purpose of the Test

There are two main reasons a person might need 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 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 in order to take a biopsy of abnormal lung or airway tissue.

To treat a lung problem or condition. 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
  • Widen (dilate) an airway that is blocked or narrowed
  • Drain an abscess
  • Wash out an airway

Bronchoscopy also can be used as part of certain treatments for lung cancer that's 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.

Risks and Complications

Most people tolerate bronchoscopy quite well with minimal complications. There are only a couple of risks—infection or, if a biopsy was performed, bleeding from the area from where tissue was removed.

Other small risks include: sIn fact, the only side Most often the only side effects . Whether you have a flexible bronchoscopy or a rigid bronchoscopy, here are the risks and complications more commonly associated with the procedure:

  • Sore throat and/or hoarseness
  • Fever
  • 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, but 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 bronchoscopy, including:

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

Before the Test

Here is pertinent information to know prior to having a bronchoscopy. it will help you to plan for the procedure.

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 that will take place, such as a biopsy. Your doctor will give you an estimate of how long you'll need to be at the hospital based on the preparation time (signing papers and preparing; the actual procedure; and recovery time).

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 requires a minimum of fuss to put on and take off, 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.

An important one may be taking 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, so be upfront about any and all medications you take, whether over-the-counter or prescription, as well any supplements you use. If you aren't sure, bring in all your medications, even your multivitamins, for your doctor to review firsthand.

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) (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 depending on your plan there may be a co-pay or co-insurance due that you will be expected to take care of on the day of the procedure. 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.

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 your knitting or some other activity to keep you occupied.

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.

During the Test

Here is an outline of what the experience of having a bronchoscopy tends to be like. Keep in mind that the procedure 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.

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 anesthesia before you go into the operating room.

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.

Throughout the Test

A bronchoscopy usually is performed by either a pulmonologist (a lung specialist) or a thoracic surgeon.

During a flexible bronchoscopy, you will be given a medication to make you sleepy (twilight sleep), and a medication 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.

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 this will happen and thanks to the medication you've been given you probably won't remember much of what your experience.

you will be taken to the operating room and given a general anesthetic prior to the procedure.

Most bronchoscopies are done using a flexible bronchoscope—one that's very thin and easy to navigate through the narrow passages it must fit through. This type of tube is less than a half inch wide and about 2 feet long.

There are some situations in which using a rigid bronchoscope is necessary. This thicker tube, which is made of metal, comes in several sizes, ranging from 2 millimeters to 14 millimeters. It must be inserted in an operating room while a patient is under general anesthesia.

Post-Test

When you are finished with your bronchoscopy, you will be taken to the recovery room where you will be monitored closely for two to four hours. You will feel groggy as the effects of the medications wear off.

Once you are able to swallow without choking, you will be allowed to eat, beginning with sips of water. Since the effects of the medications can last several hours, you will be asked to bring someone with you who can drive you home.

After the Test

For a few days after your bronchoscopy, your throat may feel irritated and you may be hoarse. You may also cough up small amounts of dark brown blood. You should call your doctor if you have any symptoms or questions that concern you. Call your doctor right away if you cough up bright red blood, however, develop a fever, or notice any worsening in your 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 parasites
  • Tuberculosis
  • Lung damage associated with an allergic-type reaction
  • Disorders in which tissues deep in the lungs become inflamed and damages 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

A Word From Verywell

In addition to its traditional role in allowing the physician to explore the bronchi, newer techniques are allowing doctors to visualize tumors within the lungs which do not extend into the bronchi. One of these techniques known as endobronchial ultrasound. 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.

Was this page helpful?
View Article Sources