Bronchoscopy Health Article

Definition

Bronchoscopy is a procedure in which a hollow, flexible tube is inserted into the airways (nose or mouth). The bronchoscope is inserted through the nose (or mouth) provides a view of the tracheobronchial tree and can be used to collect bronchial and/or lung secretions. Tissue biopsy may also be performed via the bronchoscope.

Purpose

During a bronchoscopy, the physician can visually examine the lower airways, including the larynx, trachea, bronchi, and bronchioles. The procedure is used to examine the mucosal surface of the airways for abnormalities that might be associated with a variety of lung diseases. Its use may be diagnostic or therapeutic.

Bronchoscopy may be used to examine and help diagnose:

• diseases of the lung, such as cancer or tuberculosis
• a congenital deformity of the lungs
• a suspected tumor, obstruction, secretion, bleeding or foreign body in the airways
• airway abnormalities, such as tracheal stenoses
• a persistent cough, or hemoptysis, a cough that includes blood in the sputum

Bronchoscopy may be used for the following therapeutic purposes:

• to remove a foreign body in the lungs
• to remove excessive secretions

Bronchoscopy can also be used to collect the following specimens:

• sputum
• tissue samples from the bronchi or bronchioles
• cells collected from washing the lining of the bronchi or bronchioles

If the purpose of the bronchoscopy is to take tissue samples or biopsy, a forceps or bronchial brush are used to obtain cells. Alternatively, if the purpose is to identify an infectious agent, a bronchoalveolar lavage can be used to gather fluid for culture purposes. If any foreign matter is found in the airways, it can be removed as well.

The instrument used in bronchoscopy, a broncho- scope, is a slender flexible tube that uses fiberoptic technology (very fine filaments that can bend and carry light). There are two types of bronchoscopes, a standard tube which is more rigid and a fiberoptic tube which is more flexible. The rigid instrument doesn't bend, doesn't see as far down into the lungs as the flexible one, and may carry a greater risk of causing injury to nearby structures. Because it can cause more discomfort than the flexible bronchoscope, it requires stronger anesthesia. However, it is useful for taking large samples of tissue and for removing foreign bodies from the airways.

Precautions

If the patient has severe respiratory failure and cannot breathe adequately one his or her own, the patient should be placed on a ventilator prior to bronchoscopy. It may not be appropriate to perform bronchoscopy on patients who have congestive heart failure or have experienced a recent heart attack. All patients must be constantly monitored while undergoing a bronchoscopy so that any abnormal reactions can be dealt with immediately.

Description

The procedure is ideally performed in an endoscopy room, but may be performed at the bedside. Follow institutional procedures for preoperative medications. The patient is placed in a supine position or sits upright. A pulmonologist trained to perform a bronchoscopy will spray anesthesia into the patient's mouth or nose. When the anesthetic has taken effect, the bronchoscope will be put into the patient's mouth or nose and passed into the throat. While the bronchoscope is moving down the throat, additional anesthesia is put into the bronchoscope to anesthetize the lower airways. The physician observes the trachea, bronchi, and the mucosal lining of these passageways looking for any abnormalities that may be present.

Alternative procedures

Depending upon the purpose of the bronchoscopy, alternatives may include a chest x ray or a computed tomography (CT) scan. If the purpose is to obtain biopsy specimens, one option is to perform surgery, which carries greater risks. Another option is percutaneous biopsy guided by CT.

Preparation

The patient should fast for six to twelve hours prior to the procedure and refrain from drinking any liquids the day of the procedure. Smokers should refrain from smoking for 24 hours prior to the procedure. The bronchoscopy itself takes about 45-60 minutes. Prior to the bronchoscopy, several tests will be done, including chest x ray and blood work. Sometimes a bronchoscopy is done under general anesthesia, in which case the patient will have an intravenous (i.v.) line in the arm. More commonly, the procedure is performed under local anesthesia, which is sprayed into the nose or mouth. This is necessary to inhibit the gag reflex. A sedative may be given. It is important that the patient understands that at no time will the airway be blocked and that oxygen can be supplied through the bronchoscope. A signed consent form is necessary for this procedure.