Bronchoscopy

What is a bronchoscopy?

A bronchoscopy is procedure where a doctor looks into your large airways (the trachea and bronchi). These are the main tubes that carry air into the lungs.

A fibre-optic bronchoscope is the device usually used. This is a thin, flexible, telescope (shown in the diagram). It is about as thick as a pencil.

The bronchoscope is passed through the nose, down the back of the throat, into the windpipe (trachea), and down into the bronchi. The fibre-optics allow light to shine round 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 a thin 'grabbing' instrument can pass. This can be used to take a small sample (biopsy) from the inside lining of a bronchi, or to remove small objects from the airways (such as an inhaled peanut).

Who has a bronchoscopy?

There are various reasons for having a bronchoscopy. A common reason is if you have suspected cancer of the bronchus (lung cancer). This may be because you have a 'shadow' on a chest X-ray. With a bronchoscopy a doctor can see a growth in a bronchus, and take a biopsy (small sample) to look at under the microscope. Other reasons include: if you have a persistent cough, or cough up blood, and the cause is not clear.

A rigid bronchoscope can be used to remove objects which have been inhaled, such as peanuts.

What happens during a bronchoscopy?

Bronchoscopy using a flexible bronchoscope

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. The sedative can make you drowsy, but it is not a general anaesthetic and does not 'put you 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 a soft plastic tube placed just inside your nostril to give you oxygen during the procedure.

The doctor will insert the tip of the bronchoscope into a nostril and then gently guide it round the back of your throat into your trachea (windpipe). (It is sometimes passed via the mouth rather than via the nose if you have narrow nasal passages.) The doctor looks down the bronchoscope and inspects the lining of the trachea and main bronchi (the main airways). Also, modern bronchoscopes transmit pictures through a camera attachment on to a TV monitor for the doctor to look at. The bronchoscope may make you cough.

The doctor may take one or more 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 lab for testing, and to look at under the microscope. The bronchoscope is then gently pulled out.

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.

What preparation do I need to do?

You will usually have a blood test done shortly before the bronchoscopy to check how well your blood will clot. This is to make sure that you are not likely to bleed following the procedure. 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 may need to discuss your medication with your doctor if you take such medicines for other conditions.)

In addition to this, you should get 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.

What can I expect after a flexible bronchoscopy?

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 biopsy may take a few days to come back.

Are there any side-effects or possible complications?

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 next day or so. Rarely, a bronchoscopy can cause damage to the lung. This is more likely to occur if a specialised biopsy of lung tissue is taken. This can sometimes 'collapse' a lung. Serious complications from a bronchoscopy are rare.