Bronchoscopy

What is a bronchoscopy?

A bronchoscopy is a procedure used to help diagnose conditions associated with the lungs and the airways (known as the bronchi). A bronchoscopy is carried out using a bronchoscope, of which there are two types of bronchoscope:

• Fibre-optic flexible bronchoscope: this is the most common type of bronchoscopy. The bronchoscope is a thin, flexible tube, which is roughly the same thickness as a pencil. The tube is passed through the nostrils, down the throat and trachea (windpipe) and into the bronchi. This procedure is carried out under sedation.
• Rigid bronchoscope: this type of bronchoscope is like a fine telescope and the procedure must be carried out under general anaesthetic.

Bronchoscopes have a small grabbing instrument attached to them, which allows a biopsy sample to be taken and foreign objects to be removed.

Why would I need a bronchoscopy?

There are various reasons why you would be advised to have a bronchoscopy. One of the reasons may be if your doctor suspects that you have lung cancer because you have a shadow on a chest X-ray. Your doctor may also order a bronchoscopy if you have certain symptoms, including coughing up blood and a persistent cough with no clear cause.

What happens during a bronchoscopy?

Flexible bronchoscopy

• A flexible bronchoscopy can be carried out under sedation and therefore it is often carried out as a day case or outpatient appointment. Before the procedure starts, your doctor will numb your throat using a local anaesthetic spray and help you to relax by giving you a sedative. Sedatives make you feel drowsy but they do not make you sleep in the same way as a general anaesthetic and you will come around quickly, but you will probably have no recollection of the procedure.
  
• During the procedure your doctors will keep an eye on your heart rate and blood pressure and they may attach a pulse oximeter to your finger to monitor the level of oxygen in your blood. If you need additional oxygen during the procedure, a small tube inserted into your nose will supply this.
  
• When you are ready, your doctor will insert the bronchoscope into your nostril and start to pass it through into your throat and down your trachea. Your doctor will then be able to look at your bronchi and check for abnormalities. If you have narrow nasal passages, the tube may be inserted through the mouth. Many modern instruments have a camera attachment, which can relay images onto a computer for doctors to analyse.
  
• Your doctor may take biopsies during the procedure, but this will depend on why the test is being carried out. Once the samples have been taken, they will be sent to the laboratory and the bronchoscope will be removed gently.
  
• The procedure takes around 20-30 minutes but you should allow around 2 hours to cover procedure preparation and coming around from the sedative. It is also advisable to have somebody come with you and give you a lift home after the procedure, as you may still feel a little drowsy.
  

Rigid bronchoscope

A bronchoscopy using a rigid bronchoscope will always be carried out under general anaesthetic so you will not feel anything at all or have any memory of the procedure. You will be monitored while you come around and your doctor will tell you when it is safe for you to go home.

Before the bronchoscopy

Before you have a bronchoscopy you will be sent some guidelines from the hospital and you must follow the advice given. Usually, you will be advised to avoid eating or drinking for a period of time before the test and urged to ask somebody to drive you home after the test, as you may feel drowsy from the sedative.
Before you have a bronchoscopy, you may be given a blood test to see how well your blood will clot and you will also be advised to avoid taking medication for a period of time before the procedure.

Recovering from a bronchoscopy

It will take a little while for you to come around from the sedative, so you will be monitored by nurses for a period of time after the procedure. Once you have come around, your doctor will talk to you about recovery and they will probably advise you to avoid eating and drinking for at least 2 hours, as your throat will still feel numb. You will need to arrange for somebody to take you home and it is a good idea for them to stay with you for around 24 hours. You should not drink alcohol for at least 24 hours after the procedure.

Your doctor may talk to you about what the bronchoscopy showed, but biopsy samples take a few days to come back so they may wait to discuss your results.

If you have had a rigid bronchoscopy, you will be advised to stay in hospital until you have fully come around and your doctors are happy with your condition.

Side-effects and complications

A bronchoscopy is a safe procedure and carries low risk. Some people experience mild soreness in their throat for a short period of time after the procedure and the sedative may make you feel tired and drowsy. There is a slightly higher risk of developing a chest infection after a bronchoscopy. In very rare occasions, a bronchoscopy can cause the lung to collapse but this is more common when a biopsy has been taken.