Internal examination of the bronchi (passages that carry air from the trachea – windpipe – into the lungs) using a viewing instrument called a bron-choscope. Bronchoscopy is used in the investigation of lung problems where disorders of the bronchi are suspected BIOPSY samples and bronchial secretions for MICROBIOLOGY and CYTOLOGY may be collected, inhaled foreign bodies removed, and some treatment procedures such as removal of small tumours undertaken through the bronchoscope.

Patients are asked not to smoke for at least 24 hours, and to fast for at least 6 hours before the examination (to reduce the risk of vomiting during the procedure). Asedative and a cough suppressant are given shortly beforehand and the throat is numbed with local anaesthetic spray. Flexible bronchoscopes may be introduced through the nose. As the bronchoscope proceeds through the trachea and bronchi, more anaesthetic is sprayed onto their walls to further reduce the urge to cough. Images of the interior of the bronchi are transmitted from the bronchoscope to a video screen, from which photographs can be taken from time to time at various stages of the examination.

Most people find the test unpleasant and uncomfortable, but not painful. The biggest problem is the fear of choking, but air can still flow freely in and out of the lungs while the bronchoscope is in place; Bronchoscopy generally takes about 30 minutes. Afterwards the patient may feel the urge to cough as the anaesthetic wears off, and some blood-tinged sputum may result.

A rigid bronchoscope can be used to remove objects which have been inhaled such as peanuts. If your doctor sees a suspicious area during bronchoscopy, an attachment can be placed on the end of the bronchoscope to take a small sample of tissue to be examined in a laboratory. The bronchoscopy itself usually takes about 20-30 minutes. However, you should allow at least two hours for the whole appointment to prepare, give time for the sedative to work, for the bronchoscopy itself, and to recover. There are various reasons for having a bronchoscopy. A common reason is if you have suspected cancer of the bronchus. This may be because you have a ‘shadow’ on a chest x-ray. During bronchoscopy, there is a remote risk of an allergic reaction to the anesthetics used. During bronchoscopy, a flexible bronchoscope is inserted through the mouth or nose, then slowly passed down into the trachea and bronchi.

Purpose

• Identify the cause of airway problems, such as bleeding, difficulty breathing, or inflammation from other lung diseases.
• Abnormal chest x-ray.
• Diagnose and determine the extent of lung cancer.
• Evaluate and treat growths in the airway.
• Coughing up blood.

How to prepare for the test?

• Do not eat or drink anything 6 to 12 hours before the test.
• Talk with your doctor ahead of time if you are taking insulin, or if you take aspirin, nonsteroidal antiinflammatory drugs, or other medicines that affect blood clotting.
• It may be necessary to stop or adjust the dose of these medicines before your test.
• Also tell your doctor if you have ever had an allergic reaction to the medicine lidocaine or the numbing medicine used at the dentist’s office.

What the risks are?

The main risks from bronchoscopy are:

• Bleeding from biopsy sites.
• Breathing difficulties.
• Arrhythmias.
• Low blood oxygen.
• Heart attack.
• There is also a risk that the bronchoscope could injure your nose, parts of your mouth or throat, teeth or breathing passages, or puncture the lung.
• Depressed heart rate.