Bronchoscopy allows a doctor to examine inside your airway for any abnormality such as foreign bodies, bleeding, a tumor, or inflammation. The doctor uses either a rigid bronchoscope or flexible bronchoscope.
A German, Gustav Killian, performed the first bronchoscopy in 1897. From then until the 1970s, doctors evaluated people’s airways using a rigid bronchoscope.
In the early 1970s, Ikeda introduced the flexible fiberoptic bronchoscope, which greatly enhanced the potential for the procedure. Since then, bronchoscopy has become an increasingly important diagnostic and therapeutic tool for the management of chest diseases. It is now perhaps the most common invasive procedure in the study and care of lungs. Doctors use it in these ways:
To see abnormalities of the airway
To obtain samples of an abnormality or specimens in undiagnosed infections
To obtain tissue specimens of the lung in a variety of disorders
To evaluate a person who has bleeding in the lungs, possible lung cancer, a chronic cough, or a collapsed lung
To remove foreign objects lodged in the airway
To open the spaces of a blocked airway
Rigid bronchoscopy: A rigid bronchoscope is a straight, hollow, metal tube. Doctors perform rigid bronchoscopy less often today, but it remains the procedure of choice for removing foreign material and for several other treatments. Rigid bronchoscopy also becomes useful when bleeding interferes with seeing the area.
Flexible bronchoscopy: A flexible bronchoscope is a long thin tube that contains small clear fibers that transmit light images as the tube bends. Its flexibility allows this instrument to reach the farthest points in an airway. The procedure can be performed easily and safely under local anesthesia.
Bronchoscopy - Preparation
Prior to the procedure, your doctor will discuss with you the following:
The need to do a bronchoscopy
What doctors hope to achieve
The risks of your procedure
The doctor also will do the following:
Create an accurate medical history
Examine your lungs and heart
Take a chest x-ray
Perform appropriate blood tests if you have a high risk of bleeding
You will be asked to fast for at least 6 hours before the procedure.
Bronchoscopy - During the Procedure
The bronchoscopy is performed in 1 of 3 areas:
A special room designated for such procedures
An operating room
An intensive care unit
You will be given antianxiety and antisecretory medications (to dry your mouth and membranes), generally atropine (Atropair, I-Tropine) and morphine (Duramorph, Oramorph, Roxanol), a half-hour before the procedure.
During the procedure, doctors provide an agent such as midazolam (Versed) to sedate you, although you remain conscious. Lidocaine also can be used to anesthetize your upper airways.
You will be monitored during the procedure with periodic blood pressure checks, continuous ECG monitoring of your heart and oxygen measurement. Monitoring is particularly important when you remain conscious during the procedure.
The doctor can insert a flexible bronchoscope through either your nose or mouth. You can be either sitting or lying down.
Once the bronchoscope is inserted into your upper airway, the doctor will examine your vocal cords. The doctor continues to advance the instrument to the trachea and on down, examining each area as the bronchoscope passes.
If doctors discover an abnormality, they may sample it, using a brush, a needle, or forceps.
They also may sample a large number of alveoli, the air sacs in your lungs.
Doctors can obtain a specimen of lung tissue (transbronchial biopsy) often using a real-time x-ray (fluoroscopy).
Bronchoscopy - After the Procedure
Although most adults tolerate bronchoscopy well, doctors require that you remain for a brief period of observation.
Nurses will watch you closely for 2-4 hours following the procedure.
Most complications occur early and are readily apparent at the time of the procedure.
You will be monitored until the effects of sedative drugs wear off and your gag reflex has returned.
If you have had a transbronchial biopsy, doctors will take a chest x-ray to rule out any air leakage in your lungs after the procedure.
You will be hospitalized if you show any bleeding, air leakage, or respiratory distress.
Once you are released to go home, you should not drive. Effects of the sedative medications may be lingering.
Bronchoscopy - Risks
Although the rigid bronchoscope can scratch or tear your airway or damage your vocal cords, the risk for bronchoscopy is limited. The conditions for which doctors use it are ongoing, life-threatening cardiac problems or severely low oxygen.
Complications from fiberoptic bronchoscopy remain extremely low.
Common complications include either heart and blood vessel problems or excessive bleeding following biopsy.
A lung biopsy also may cause leakage of air called pneumothorax. Pneumothorax occurs in less than 1% of cases requiring lung biopsy.