What is Bronchoscopy?

Bronchoscopy is a very useful and common test for lung disease. It is a procedure used to look inside the lungs' airways, called the bronchi and bronchioles using an instrument called a bronchoscope. It can help to make a diagnosis or treat lung disease.

During the procedure, the doctor passes a long, thin, lighted flexible tube to look at the airways. The tube is passed through the nose or mouth, down the throat, and into the airways.

How to prepare for the procedure?

Discuss with your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will indicate. A consent form needs to be signed before a bronchoscopy.

Before the procedure, tell your doctor:

  • If you are taking any medicines, including prescription and over-the-counter medicines
  • About any allergies to medicines or latex.
  • About any previous bleeding problems or if you are taking blood-thinners, such as aspirin, clopidogrel (Plavix) or warfarin (Coumadin).
  • If you are or might be pregnant.

Do not eat or drink for at least 8 hours before the procedure.
Arrange to have someone drive you home after the procedure.

How is a Bronchoscopy done?

The procedure is done by a pulmonologist and an assistant. 

The doctor sprays a local anesthetic into the nose and mouth. This numbs your throat and reduces your gag reflex during the procedure.

A sedative is given through an intravenous line placed in a vein. This will keep you awake but sleepy during the procedure.

The bronchoscope is then gently passed either through the nose or the mouth, and then advanced slowly down the back of the throat, to the vocal cords. Then more anesthetic is sprayed through the bronchoscope to numb the vocal cords. You may be asked to take a deep breath so the scope can pass your vocal cords. The bronchoscope is then moved down the larger breathing tubes (bronchi) to examine the lower airways.

The doctor then collects fluid or tissue samples for biopsy using a tiny biopsy tool or brush through the scope. Occasionally, the exam is done with the aid of X-ray equipment to help your physician locate the exact area from which to take biopsy specimens. A salt (saline) fluid may be used to wash the airway, then the samples are collected and sent to the lab to be studied.

Finally, small biopsy forceps may be used to remove a sample of lung tissue. This is called a transbronchial biopsy

What to expect after a flexible bronchoscopy?

When the procedure is finished, you will be observed by a nurse until you are awake enough to leave. Tell the nurse if you have any chest pain, difficulty breathing, or notice a large amount of blood (more than one tablespoon) in your sputum. It is normal to cough up a small amount of blood for 1–2 days after the procedure. The nose and throat may be sore.

If you have had sedatives it is important that you do not do any of the following in the 24 hours after your tests.

Do not:

  • Drive
  • Operate machinery or domestic appliances as your reaction times may be slowed down
  • Drink alcohol, as this would increase the effect of your sedation and make your reactions even slower
  • Do any energetic exercise or lift heavy weights

Please follow the doctors and nurses instructions. After your test you may have light meals and warm drinks for the rest of the day.

Interventional Bronchoscopy

Benefits include possibly avoiding surgery. CT scan can be used to create 3D map of the airways. Electromagnetic navigational bronchoscopy (ENB) is then used like a GPS to drive to the target as small as 1/3 of an inch or half the diameter of a dime.

Endobrochial ultrasound (EBUS) uses real-time imaging to sample enlarged lymph nodes.

With advances in bronchoscopy treatment can now be delivered for lung cancer, asthma, emphysema. Techniques include airway stent placement, cryotherapy, bronchial thermoplasty, endobronchial valve placement.

Airway stents are tube shaped devices that can open blocked airways from cancer.

Cryotherapy is the use of low temperature to destroy tissue.

Severe asthma may not respond to usual treatment. Bronchial thermoplasty is the use of heat applied to the muscles of airways in patients'. This opens the airways making it easier to breathe.

Endobronchial valves may be an alternative treatment for persistent air leak. This can decrease length of hospitalization.

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