A bronchoscopy is a test that allows your doctor to examine your airways. The procedure uses one of two types of instruments known as bronchoscopes:
- a flexible bronchoscope
- a rigid bronchoscope
The flexible type is more common and can be used in an office setting after administering relaxing medication. The rigid type is used if you have bleeding in your lungs or a large object is obstructing your airways. A rigid bronchoscopy is performed in a hospital setting under anesthesia.
During a bronchoscopy, your doctor will thread the bronchoscope through your nose or mouth and down your throat to reach your lungs. The bronchoscope has a light source and a camera on the end. Most bronchoscopes are compatible with color video, which helps your doctor document their findings.
Using the bronchoscope, your doctor can view all the structures that make up your respiratory system. These include your larynx, your trachea, and the smaller airways of your lungs, which are called the bronchi and bronchioles.
Taking a look through the bronchoscope can help your doctor diagnose and treat any lung-related issues you’re experiencing. Your doctor may also collect biopsies of airway secretions or tissues to help diagnose lung and airway conditions.
A bronchoscopy can be used to diagnose:
- a lung disease
- a tumor
- a chronic cough
- an infection
The procedure can also be used to detect the source of pulmonary bleeding or identify foreign bodies in young children.
Your doctor may order a bronchoscopy if you have an abnormal chest X-ray or CT scan that shows evidence of an infection, a tumor, or a collapsed lung.
The procedure is also sometimes used as a treatment tool.
A bronchoscopy can allow your doctor to deliver medication to your lungs or remove an object that’s caught in your airways, such as a piece of food. The procedure can also be used to administer laser treatment for certain small tumors.
If needed, bronchoscopy can be used to place small stents in the airways to keep them open.
Bronchoscopy is safe for most people. However, like all other medical procedures, it does come with some risks, such as:
- bleeding, especially if a biopsy is done
- trouble breathing
- a low blood oxygen level during the test
Contact your doctor if you:
- have a fever
- cough up blood
- have trouble breathing
These symptoms can indicate a complication that requires medical attention, such as an infection.
Topical anesthesia used during bronchoscopy can have rare complications such as voice box or airway spasms, seizures, or cardiac arrhythmias (abnormal heart rhythms).
Very rare but potentially life threatening risks of the procedure include heart attack and lung collapse.
A collapsed lung can be due to a pneumothorax, or increased pressure on your lung due to the escape of air into the lining of your lung. This results from a puncture of the lung during the procedure and is more common with a rigid bronchoscope than with a flexible fiber-optic scope.
If air collects around your lung during the procedure, your doctor can use a chest tube to remove the collected air.
Who shouldn’t get a bronchoscopy?
Some people cannot undergo a bronchoscopy. Your doctor may not recommend the procedure if you have:
- tracheal stenosis (severe narrowing or blockage of the trachea)
- pulmonary hypertension (high blood pressure in the blood vessels of the lungs)
- recently had heart attack
- certain types of cardiac arrhythmias
- an untreatable bleeding disorder
- severe coughing or gagging
- low oxygen levels
In addition, your doctor may put you on a breathing machine before the procedure if you have hypercapnia (high levels of carbon dioxide in your blood) or severe shortness of breath. This is to ensure that your lungs are getting oxygen during the bronchoscopy.
A local anesthetic spray is applied to your nose and throat during a bronchoscopy. You’ll probably get a sedative to help you relax. This means you’ll be awake but drowsy during the procedure. Oxygen is usually given during a bronchoscopy. General anesthesia is rarely needed.
You’ll need to avoid eating or drinking anything for 6 to 12 hours before the bronchoscopy. Be sure to review a list of all medications you take, including prescriptions, over the counter, vitamins, and herbal supplements with your doctor. Before the procedure, you may need to need to stop taking:
- aspirin (such as Bayer)
- ibuprofen (such as Advil)
- other blood thinners
Bring someone with you to your appointment to drive you home afterward, or arrange for transportation.
Once you’re relaxed, the procedure will begin, going through the following steps:
1. Your doctor will insert the bronchoscope into your nose.
2. Your doctor will navigate the instrument from your nose down to your throat until it reaches your bronchi. The bronchi are the airways in your lungs.
3. Your doctor may have attached brushes or needles to the bronchoscope. If so, at this point, they will use those to collect tissue samples from your lungs. These samples can help your doctor diagnose any lung conditions you may have.
4. Your doctor may also use a process called bronchial washing to collect cells. This involves spraying a saline solution over the surface of your airways. The cells that are washed off the surface are then collected and looked at under a microscope
5. Depending on your specific condition, your doctor may find one or more of the following:
- an infection
- a blockage
- a tumor
6. If your airways are blocked, you might need a stent to keep them open. A stent is a small tube that can be placed into your bronchi with the bronchoscope.
7. When your doctor is finished examining your lungs, they’ll remove the bronchoscope.
Types of imaging used in a bronchoscopy
Advanced forms of imaging are sometimes used to conduct a bronchoscopy. Advanced techniques can provide a more detailed picture of the inside of your lungs:
- During a virtual bronchoscopy, your doctor uses CT scans to see your airways in more detail.
- During an endobronchial ultrasound, your doctor uses an ultrasound probe attached to a bronchoscope to see your airways.
- During a fluorescence bronchoscopy, your doctor uses a fluorescent light attached to the bronchoscope to see the inside of your lungs.
A bronchoscopy is relatively quick, lasting 30 to 45 minutes. Because you’ll be sedated, you’ll rest at the hospital for a couple of hours until you feel more awake and the numbness in your throat wears off. Your breathing and vital signs, including your blood pressure, heart rate, and oxygen levels, will be monitored during your recovery.
You won’t be able to eat or drink anything until your throat is no longer numb. This can take 1 to 2 hours. Your throat might feel sore or scratchy for a couple of days, and you might be hoarse. This is normal. It usually doesn’t last long and goes away without medication or treatment.