Bronchoscopy is a procedure that is done to examine the lungs and air passages. It is usually performed by a pulmonologist. During bronchoscopy, a thin tube called a bronchoscope is passed through the nose or mouth, down the throat and into the lungs.

Bronchoscopy is most commonly performed using a flexible bronchoscope. However, in certain situations, such as if there is a lot of bleeding in lungs or a large object is stuck in the airway, a rigid bronchoscope may be needed. Common reasons for needing bronchoscopy are a persistent cough, infection or something unusual seen on a chest X-ray or other test. Bronchoscopy can also be used to obtain samples of mucus or tissue, to remove foreign bodies or other blockages from the airways of the lungs, or to provide treatment for lung problems.

Why Bronchoscopy is performed?

Bronchoscopy is usually done to find the cause of a lung problem. For example, the doctor might refer for bronchoscopy because patient might have persistent cough or an abnormal chest X-ray.

Reasons for doing bronchoscopy include:

• Identification of a lung infection

• Diagnosis of a lung problem

• Biopsy of tissue from the lung

• Removal of mucus, a foreign body, or other obstruction in the airways or lungs, such as a tumor

• Placement of a small tube to hold open an airway (stent)

• Treatment of a lung problem (interventional bronchoscopy), such as bleeding, an abnormal narrowing of the airway (stricture) or a collapsed lung (pneumothorax)

During some procedures, special devices may be passed through the bronchoscope, such as a tool to obtain a biopsy, an electrocautery probe to control bleeding or a laser to reduce the size of an airway tumor. Special techniques are used to guide the collection of biopsies to ensure the desired area of the lung is sampled.

In patient with lung cancer, a bronchoscope with a built-in ultrasound probe may be used to check the lymph nodes in the chest. This is called endobronchial ultrasound (EBUS) and helps doctors determine the appropriate treatment. EBUS may be used for other types of cancer to determine if the cancer has spread.

What are the risks of Bronchoscopy

Complications from bronchoscopy are usually rare and minor, although they are rarely severe. Complications may be more likely if airways are inflamed or damaged by disease. Complications may be related to the procedure itself or to the sedative or topical numbing medicine.

• Bleeding- Bleeding is more likely if a biopsy was taken. Usually, bleeding is minor and stops without treatment.

• Collapsed lung- In rare cases, the airway may be injured during bronchoscopy. If the lung is punctured, air can collect in the space around the lungs, which can cause the lung to collapse. In this case admission is required for the treatment.

• Fever- Fever is relatively common after bronchoscopy but is not always a sign of infection. Treatment is generally not needed.

Preparations for Bronchoscopy

Preparation for bronchoscopy usually involves restrictions in food and medications, other precautions involved are:

Food and medications

Patient is asked to stop taking blood-thinning medications for several days before bronchoscopy also be asked not to eat or drink for four to eight hours before the procedure.

Other precautions

To go home after the procedure, attendant is needed to take home.

Bronchoscopy is done in a procedure room in a hospital operating room. The entire procedure, including prep and recovery time, typically takes about four hours. Bronchoscopy takes about 30 to 60 minutes.

Before the procedure

Patient will be asked to lie back on a bed with the arms at sides, then it is connected to monitors so that the doctor can track the heart rate, blood pressure and oxygen level during the procedure. A sedative medicine is given through a vein (intravenously) to help in relaxing.  Patient will be able to indicate a response to any questions the doctor may ask during the procedure. Sedative medications often results having very little memory of the bronchoscopy procedure once it is completed.

To numb the throat a medication called an anesthetic will be sprayed in the throat, helping to lessen gagging and coughing as the bronchoscope is placed into the throat. At first the medicine may taste unpleasant, but the taste will go away.

During the procedure

During bronchoscopy, the bronchoscope is placed in the nose or mouth. The bronchoscope has a light and a very small camera at its tip that displays pictures on a monitor to help guide the doctor in performing the procedure. The bronchoscope is advanced slowly down the back of the throat, through the vocal cords and into the airways. It may feel uncomfortable, but it shouldn't hurt. Doctor will try to make patient as comfortable as possible.

Tissue sample and fluid may be taken and procedures may be performed using devices passed through the bronchoscope. Doctor may ask if patient have pain in chest, back or shoulders. In general, patient should not feel pain.

After the procedure

Patient will be monitored for several hours after bronchoscopy. The mouth and throat will probably be numb for a couple of hours. Eating or drinking is not allowed until the numbness wears off. This helps keep food and liquids from entering the airways and lungs. When the mouth and throat are no longer numb, and patient is able to swallow and cough normally again, can have something to drink. Start with sips of water after that may eat soft foods, such as soup. Add other foods gradually as per the comfortable.

It is normal to have a mild sore throat, hoarseness, a cough or muscle aches. This is normal. Warm water gargles and throat lozenges can help lessen the discomfort. Before gargling or sucking on lozenges numbness is should be not present.

In case of the following cases, consult your doctor:

1. Have increasing chest pain

2. Having a fever that lasts more than 24 hours

3. Having trouble breathing

4. Blood while coughing