A bronchoscopy is a procedure that allows a doctor to examine the inside of the lungs, including the bronchi, which are the main pathways into the lungs.
During a bronchoscopy, a doctor inserts a thin tube containing a light and camera into the lungs through the nose or mouth. The doctor can use the findings to diagnose infections, tumors, or diseases in the lungs.
It is a relatively quick and painless procedure, it requires little preparation, and people tend to recover quickly.
In this article, we describe what to expect before, during, and after a bronchoscopy. We also discuss the uses of this procedure and associated complications.
Doctors use bronchoscopy to detect the cause of breathing difficulties and lung problems, such as tumors, infection, and bleeding.
During the procedure, a doctor may also insert stents in the airways or take a biopsy, which involves removing a small sample of tissue for testing.
A doctor may recommend a bronchoscopy to:
- follow up on a scan that has indicated a lung infection or tumor, or a collapsed lung
- determine why someone is coughing up blood
- find the cause of a chronic cough
- discover the reason for shortness of breath
- look for blockages in the airways
- check for lung rejection, following a transplant
- assess damage after someone has inhaled chemicals or toxic gases
- take a biopsy
Doctors also use bronchoscopies to treat certain conditions, for example, by:
- removing fluid, mucus plugs, or foreign objects in the airways
- widening a blocked or narrowed airway
- treating cancer
- draining an abscess
Most people are awake during a bronchoscopy. Before the procedure, a doctor sprays a local anesthetic into the nose and throat to numb the area. Many people also take a sedative to help them relax.
Doctors only recommend a general anesthetic in rare cases, when they will be using a rigid bronchoscope.
Once the anesthetic takes effect, the doctor will usually insert a flexible bronchoscope tube through the nose and throat and into the bronchi. As the tube moves into the lungs, a person may feel a pressing or tugging sensation.
Some people initially cough or gag, but this usually subsides quickly. A doctor may administer oxygen throughout the procedure may to aid breathing.
The bronchoscope's light and camera help the doctor to see the airways clearly, even around bends.
If a doctor needs to insert a stent or take a biopsy, they can pass brushes, needles, and other instruments through a channel in the bronchoscope. A stent is a small tube that helps to keep blocked or narrow airways open.
A doctor sometimes sprays a saline solution through the airways, in a process called bronchial washing, or lavage, to collect cells and fluids. The doctor will later examine them under a microscope.
During the bronchoscopy, a doctor may take an ultrasound, to get a clearer picture of the lymph nodes and tissues in and around the bronchi.
Once they are finished checking the airways, the doctor will remove the bronchoscope. The procedure usually takes 20–30 minutes, although times can vary, depending on the number of examinations and the underlying issue.
Most people can return home on the day of the procedure.
Follow the doctor's advice. They will often recommend that a person avoids eating or drinking for a specified period.
Discuss any current medications with the doctor, especially blood thinners such as aspirin or warfarin. The doctor may advise against taking some medications shortly before the procedure.
It is important to follow specific instructions, especially concerning medication use.
Arrange a ride to and from the hospital, because it is not safe to drive after taking sedatives. To allow time for recovery, it may be a good idea to organize help with work and childcare.
A bronchoscopy is a relatively quick and painless procedure. Afterward, a person will need to remain at the hospital for a few hours until the medications wear off. Blood pressure and breathing are monitored during this time to check for complications.
The ability to cough, called the cough reflex, should return within 2 hours. After this, it is safe to eat and drink again. After taking a sedative, a person should avoid driving, operating machinery, and drinking alcohol for 24 hours.
Most people can return to regular activities after 24 hours, but it is normal to have a sore throat and hoarseness for a few days.
Immediately after the medications wear off, the doctor may share what they saw during the procedure. Other results, including those of a biopsy, can take several days or weeks to arrive.
Normal results of a bronchoscopy mean that the doctor did not see any foreign materials, blockages, or unusual cells or fluids in the bronchi.
If results are abnormal, the doctor will recommend further tests or treatments, depending on the outcome.
Abnormal results can indicate one or more of the following issues:
- bacterial infection
- viral infection
- fungi or parasites
- inflammation of lung tissue
- lung damage
- narrowing of the trachea or bronchi
- rejection of a transplanted lung
Bronchoscopy is usually safe, but there are certain risks.
There is a small chance that a person may develop:
- an abnormal heartbeat, which is called an arrhythmia
- breathing difficulties
- low blood oxygen levels during the procedure
- minor bleeding, especially after a biopsy
Also, a person with a history of heart conditions may have an increased risk of heart attack.
Rarely, a bronchoscopy can cause a lung to collapse, which is called pneumothorax. This happens if the lung is punctured during the procedure. It is more likely if a doctor is using a rigid rather than a flexible scope.
Pneumothorax is serious and requires treatment. A doctor may perform a chest X-ray after a bronchoscopy to check the lungs for signs of collapse.
When a person has general anesthesia, additional risks include:
- blood pressure changes
- muscle pain
- a slow heart rate
A bronchoscopy is a safe procedure with a low risk of serious complications. Mortality rates for both flexible and rigid bronchoscopy procedures are less than 0.1 percent.
Doctors commonly use local anesthesia and sedatives to keep individuals comfortable and relaxed during the examination.
Contact a doctor if any of the following symptoms arise after a bronchoscopy:
- breathing difficulties
- chest pain
- coughing up blood
- a rapid heart rate
These symptoms can suggest complications that require medical treatment.