A bronchoscopy (or fiberoptic bronchoscopy) is a procedure that allows the doctor to view the respiratory tract through a fiberoptic tube (bronchoscope) and diagnose lung disease. This procedure also enables the doctor to collect samples of lung tissues, cells or fluids. It may also be used during the treatment of some lung conditions.
HOW IS THE TEST PERFORMED?
A bronchoscope is a flexible tube with a camera at the end. The tube is passed either through the mouth or nose and into the respiratory tract, through your windpipe (trachea), and then into your lungs. Going through the nose is a good way to look at the upper airways. The mouth method allows the doctor to use a larger bronchoscope.
Most of the times you will be awake during the procedure:
- Dentures and/or plates must be removed.
- You will likely get drugs through a vein (intravenously) to help you relax. Only rarely will you be asleep under general anaesthesia.
- Next you will be assisted into the proper position. The head of the bed will be elevated so that you are in a sitting position. Your head will be extended back as if you were looking at the ceiling
- The doctor will spray a numbing drug (anaesthetic) in your mouth and throat to decrease discomfort and gagging that can occur when the scope is inserted. If the bronchoscopy is done through the nose, numbing jelly will be placed on one nostril. The anaesthetic has an unpleasant taste and you will begin to feel your throat get numb.
- Inserting the bronchoscope will make you cough at first. The coughing will stop as the numbing drug begins to work. When the area feels thick, it is numb enough.
Once you are numb, the procedure will then begin and the tube will be inserted into the lungs.
- It is not uncommon to require oxygen through a tube in your nose or by a mask over your face during the procedure and for a short time afterward. A heart monitor may also be used during the procedure
- The doctor may send saline solution through the tube. This washes the lungs and allows the doctor to collect samples of lung cells, fluids, and other materials inside the air sacs. This part of the procedure is called a lavage.
- Sometimes, tiny brushes, needles, or forceps may be passed through the bronchoscope and used to take very small tissue samples (biopsies) from your lungs.
- The doctor can also place a stent in the airway
WHY IS THE TEST PERFORMED?
You may have a bronchoscopy to help your doctor diagnose lung problems. Your doctor will be able to inspect the airways or take a biopsy sample.
Common reasons to perform a bronchoscopy for diagnosis are:
- Lung growth, lymph node, atelectasis, or other changes seen on an x-ray or other imaging test
- Suspected interstitial lung disease
- Coughing up blood (haemoptysis)
- Possible foreign object in the airway
- Cough that has lasted more than 3 months without any other explanation
- Infections in the lungs and bronchi that cannot be diagnosed any other way or need a certain type of diagnosis
- Inhaled toxic gas or chemical
- Remove fluid or mucus plugs from your airways
- Widen (dilate) an airway that is blocked or narrowed
- Drain an abscess
- Treat cancer using a number of different techniques
- Wash out an airway (therapeutic lavage)
HOW TO PREPARE FOR THE TEST?
Usually, the test is done as an outpatient procedure, and you will go home the same day. Some patients may need to stay overnight in the hospital.
- Your doctor will explain the procedure and get your written consent
- Before the procedure, blood tests are sometimes required.
- No food for at least four hours before the procedure, however clear fluids are allowed up to 2 hours before
- Your doctor may also want you to avoid any aspirin, ibuprofen, or other blood-thinning drugs before the procedure.
- Intravenous catheter will be placed so that medications can be given if needed.
You may be sleepy after the test, so you should arrange for transportation to and from the hospital.
Many people want to rest the following day, so make arrangements for work, child care, or other obligations.
HOW THE TEST WILL FEEL?
Local numbing medicine (anaesthesia) is used to relax and numb your throat muscles. Until the anaesthetic begins to work, you may feel fluid running down the back of your throat and have the need to cough or gag.
Once the medicine takes effect, you may feel pressure or mild tugging as the tube moves through the windpipe (trachea). Although many people feel like they might suffocate when the tube is in the throat, there is NO risk of this happening. The medicines given to relax you help with these symptoms and will help you forget most of the procedure.
When the anaesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 – 2 hours. You will not be allowed to eat or drink until your cough reflex returns.
When the bronchoscopy is done, your voice is likely to be hoarse and your throat sore. These effects are temporary. You will be asked to temporarily avoid coughing and to spit out saliva/sputum into a basin until you can swallow normally.
The anaesthetic spray used on your throat just prior to the procedure can continue to affect your ability to swallow properly for up to four hours after the procedure. Therefore, you will not be allowed to eat or drink until your swallowing reflex has returned. The nurse will test this by tickling your throat with a cotton swab. Once the swallowing reflex has returned, you will be offered sips of water. Until your swallowing reflex returns you will also need to remain sitting upright in bed.
Once the swallowing reflex has returned, salt water gargles and lozenges may be helpful for sore throat.
Smoking after having a bronchoscopy is discouraged, as it will increase irritation in respiratory tract.
WHAT ARE THE RISKS?
The main risks from bronchoscopy are:
- Sore throat
- Bleeding from biopsy sites: when a biopsy is taken, there is a risk of severe bleeding (haemorrhage). Some bleeding is common. The technician or nurse will monitor the amount of bleeding.
- There is a risk of choking if anything (including water) is swallowed before the numbing medicine wears off.
There is also a small risk of:
- Breathing difficulties
- Heart attack, in people with existing heart disease
- Low blood oxygen
- Pneumothorax (collapsed lung)
Please inform your doctor if you should develop any of the following: shortness of breath, wheezing, bloody sputum, fever, chest pain.
After the procedure your doctor will discuss some of the initial results with you. The specimens are sent to the lab for testing. It takes 48 to 72 hours for the final results for most tests but some investigations may take a few more days.
You usually will need to come back to see your doctor to discuss the results a few days after the procedure.