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Bronchoscopy – Airway Examination Explained

Bronchoscopy is a diagnostic and therapeutic procedure used to examine the airways and lungs from the inside. A flexible or rigid tube with a camera is inserted through the mouth or nose.

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Things worth knowing about "Bronchoscopy"

Bronchoscopy is a diagnostic and therapeutic procedure used to examine the airways and lungs from the inside. A flexible or rigid tube with a camera is inserted through the mouth or nose.

What is Bronchoscopy?

Bronchoscopy is a medical procedure that allows a physician to directly view the inside of the airways, including the windpipe (trachea) and the bronchial tubes, using a specialized instrument called a bronchoscope. The bronchoscope is a thin, flexible or rigid tube equipped with a light source and a miniature camera. It is inserted through the mouth or nose and provides a direct view of the lower airways and portions of the lungs.

Types of Bronchoscopy

Flexible Bronchoscopy

Flexible bronchoscopy is the most commonly performed type. The soft, pliable bronchoscope adapts well to the natural anatomy of the airways and is typically performed under local anesthesia combined with mild sedation. It is suitable for both diagnostic and certain therapeutic purposes.

Rigid Bronchoscopy

Rigid bronchoscopy uses a solid, tube-shaped instrument and is usually performed under general anesthesia. It is primarily used for therapeutic interventions, such as removing foreign bodies from the airways, managing severe airway bleeding, or treating tumors.

When is Bronchoscopy Performed?

Bronchoscopy is indicated in a variety of clinical situations. Common reasons include:

Persistent or unexplained cough
Coughing up blood (hemoptysis)
Suspected lung cancer or other pulmonary tumors
Investigation of abnormal findings on chest X-ray or CT scan
Suspected respiratory infections (e.g., tuberculosis, fungal infections)
Collection of tissue samples (biopsy) or cell samples
Removal of foreign bodies from the airways
Treatment of airway narrowing (stenosis)
Placement of stents in the bronchi
Follow-up after lung transplantation

Preparation for the Procedure

Patients are typically required to fast for several hours before bronchoscopy – usually at least 6 hours without solid food and 4 hours without liquids. Any current medications, especially blood thinners, should be discussed with the treating physician in advance. Before the procedure, a sedative is often administered, along with a local anesthetic (spray or gel) applied to the mouth, throat, and windpipe to reduce the gag reflex and make the procedure more comfortable.

How the Procedure is Performed

The examination is usually carried out with the patient lying down or in a slightly elevated seated position. The bronchoscope is carefully guided through the nose or mouth, past the throat and the vocal cords (glottis), into the trachea and then into the bronchial tubes. Instruments for biopsy, suctioning, or fluid collection can be passed through the working channel of the bronchoscope as needed. Bronchoalveolar lavage (BAL) is a special rinsing technique in which small amounts of saline solution are instilled into the lung alveoli and then suctioned back to retrieve cells and pathogens for analysis. The entire procedure typically takes 15 to 30 minutes.

Possible Risks and Side Effects

Bronchoscopy is a safe procedure that, when performed by experienced specialists, carries a low risk of complications. Potential side effects include:

Temporary cough and hoarseness after the procedure
Mild fever following bronchoalveolar lavage
Minor bleeding risk after tissue sampling
Rare risk of pneumothorax (collapsed lung) following biopsy
Very rarely: allergic reactions to anesthetic agents or sedatives

Aftercare

After the procedure, patients are usually monitored for a few hours until the effects of the sedative wear off. The local anesthesia in the throat typically lasts 1 to 2 hours – during this time, patients should not eat or drink to prevent aspiration. Driving a vehicle is not permitted on the day of the procedure. Mild discomfort such as a sore throat or irritating cough may persist for a few hours.

References

British Thoracic Society – Guidelines on Diagnostic Flexible Bronchoscopy in Adults. Thorax, 2013; 68(Suppl 1): i1–i44.
Herth F.J.F. et al. – Flexible Bronchoscopy. In: Murray and Nadel's Textbook of Respiratory Medicine, Elsevier, 2022.
Ernst A., Silvestri G.A., Johnstone D. – Interventional Pulmonary Procedures: Guidelines from the American College of Chest Physicians. Chest, 2003; 123(5): 1693–1717.

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