A Guide to a Bronchoscopy Procedure

Overview

Endoscopy refers to a procedure where doctors can see inside various parts of the body e.g., your gastrointestinal (GI) tract and your respiratory tract.  Bronchoscopy  refers to the procedure which allows your doctor (a pulmonologist) to look into your respiratory passages i.e., your trachea, lungs, air passages.  

Bronchoscopy is usually performed with the help of a flexible tube-like bronchoscope. It is passed through your nose or mouth down your throat into your air passages. Bronchoscopy is used to assess different parts of your respiratory tract i.e.; they are structurally and functionally fine. It may also be used to take biopsies (tissue samples) from the lining of the airways. Foreign bodies getting stuck in the airway tract can also be taken out using a bronchoscope. In this article, we will look into some details about bronchoscopy.  

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Indications

A bronchoscope is a useful procedure for a lot of different situations (mostly lung problems). Some of the most common indications for bronchoscopy are: 

  • Persistent cough  
  • Haemoptysis – coughing up blood 
  • Chest pain  
  • Having difficulty in breathing  
  • An abnormal chest X-ray  
  • Diagnosis of lung infection  
  • Finding a tumour in your respiratory tract  
  • Acute respiratory insufficiency – when you can’t keep your airways open so a tube is inserted into your lungs for you to breathe 
  • Trapping of foreign body in your airways – i.e., food particle, beads, etc. As a side note, most of the foreign bodies lodge at your right bronchus as it starts earlier and is straighter than the left bronchus.  
  • Pneumothorax – collapsing of the lung due to rupture. 

Risk of the Procedure

Bronchoscopy is usually a risk-free procedure with complications occurring very rarely. You are more like to experience complications if your airways are inflamed or already damaged by some underlying disease.  

As with other endoscopic procedures, you will be administered some form of anaesthesia which may cause some side effects like drowsiness, headaches, diarrhea, or constipation, etc. Some rare complications that might occur are: 

  • Bleeding – bleeding can occur during the procedure of taking a biopsy.  
  • Lung collapse – injury to the airways like if the lung is punctured can cause lung collapse due to accumulation of air in the lungs.  
  • Fever – Fever is a minor but fairly common side effect of bronchoscopy. However, it is not usually a sign of infection. 

Patient Preparation

Preparation of bronchoscopy consists of several precautions.  

  • Food and medications – it is generally advised to avoid food at least 4-8 hours before your bronchoscopy. Certain medications are usually needed to discontinue a few days before your test. These medications include blood-thinners like aspirin, clopidogrel, and warfarin (coumadin). You should also inform your doctor about any other medications you take.  
  • Clothing – on the day of your examination you would have to change into a hospital gown. You would also have to take any type of dentures, removable bridges out of your mouth. You might also need to remove hearing aids, contact lenses, or glasses.  

Taking someone with you for the test is advised as the sedative would you lead to an altered mental state.  

Procedure

The procedure takes a total of 30 – 60 minutes. You would be sat down or laid down on a table with your arms at your side and your body connected to monitors to check your vitals like heart rate, blood pressure, etc.  

You’ll then be given a sedative medicine intravenously (IV) so that you can relax and avoid pain and discomfort. The sedation is usually conscious sedation in which you’re sleepy but awake. Sometimes a numbing spray or cream may be applied or spray to numb your airways.  

During the procedure, the doctor will insert a bronchoscope into your nose. The bronchoscope is a tube-like structure with a light and camera at the inserted end. This camera lets the doctor visualise your airways. The bronchoscope is slowly advanced down into your throat and then your airways. It might feel uncomfortable but it should not be painful. Your doctor might ask you if you have any pain in your chest, back, or shoulders. 

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Patient Recovery 

The bronchoscopy is followed up monitoring for several hours i.e., your doctors will examine you to cater any complications. You’ll have some sedative and analgesic (numbing) effects of the medication. Your mouth and nose may feel numb for at least a couple of hours.  

Usually, food and drinks are contraindicated (avoided) until the effects of the medication wear off. This precaution is taken to avoid any foreign object obstructing your airways and lungs.  

You’re allowed to eat or drink once you start feeling normal in your mouth and throat. You should start with taking small sips of water or some fluid.  

The effects of the anaesthetics given usually last for some hours or a day. You should bring along someone from your home or your friend to take you back home. You should rest and relax for the remaining day and drink plenty of fluid in order to excrete the sedatives.  

Due to the tube being passed through your nose or mouth, you might feel a sore throat or a bit of hoarseness in your voice. You can add warm water gargles to your routine for a day or two to soothe out your throat.  

You should contact your doctor if you experience: 

  • Have a fever lasting 24 hours or more  
  • Increasing chest pain  
  • Have trouble breathing  
  • Cough up a couple of tablespoons of blood.  

Outcomes 

Your doctors will discuss your bronchoscopy results between 1-3 days of your test. Your doctor will then diagnose, start treatment, or alter treatment for a present illness. In case of diseases like cancer, you may need other tests including further bronchoscopies in the future.  

Biopsies taken are examined by a pathologist and the reports can take longer due to a more time requiring process. You should discuss all the details of your results and findings with your doctor as this will help you make a good decision for your health. 

References
  1. AskMayoExpert. Bronchoscopy. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. 
  1. Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Oct. 16, 2018. 
  1. Bronchoscopy. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/bronchoscopy. Accessed Feb. 4, 2019. 
  1. Bronchoscopy. Merck Manual Professional Version. https://www.merckmanuals.com/professional/pulmonary-disorders/diagnostic-and-therapeutic-pulmonary-procedures/bronchoscopy. Accessed. Feb. 4, 2019. 
  1. Board certification. American Association for Bronchology and Interventional Pulmonology. https://aabronchology.org/board-certification/. Accessed Feb. 4, 2019. 
  1. Manthous C, et al. Flexible bronchoscopy (airway endoscopy). American Journal of Respiratory and Critical Care Medicine. 2015;191:7. 
  1. Welcome to the AABIP―Who we are. American Association for Bronchology and Interventional Pulmonology. http://aabronchology.org/about/. Accessed Jan. 25, 2016. 
  1. Olson EJ (expert opinion). Mayo Clinic, Rochester, Minn. March 29, 2019. 

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