Bronchoscopy

What Is Bronchoscopy?

Bronchoscopy (pronounced “brahn KAH skoh pee”) is a medical procedure that allows a doctor to see inside a person’s airways. The airways are called the bronchial tubes or bronchi. In this procedure, the doctor inserts a small tube called a bronchoscope through the nose or mouth. The tip of this tube is lighted, so the doctor can see inside the airways.

In addition to the viewing lens, most bronchoscopes have a thin channel inside. That channel can carry water, anesthetic, or very small tools into the airways. It can also be used to obtain small bits of tissue, so they can be tested for cancer or other diseases.

There are two kinds of bronchoscopes – flexible and rigid. Doctors usually use the flexible bronchoscope for most purposes.

Flexible bronchoscopes are very thin tubes that either use fiberoptics or a tiny camera.

• Fiberoptics carry an image through a glassy wire, up to a viewing lens that the doctor looks through.
• A video bronchoscope replaces the fiberoptics with a tiny camera at the tip. The image travels through a wire to a monitor, where the doctor can see it.

Rigid bronchoscopes are small metal tubes with a light at the tip. They are used to treat certain problems in the airways. For example, a doctor might use a rigid bronchoscope to remove a foreign object too big to be removed with a flexible bronchoscope. Doctors also use them to install a small firm tube called a stent that can keep the airways open.

What Can Bronchoscopy Do?

The bronchoscope lets doctors see and fix a number of problems in the airways. They can:

• Find obstructions, tumors, and foreign objects.
• Get tissue samples from the bronchial tubes or lungs to be tested for cancer or other diseases.
• Diagnose lung cancer, tuberculosis, infection, and other airway diseases.
• Find the source of bleeding in someone who has been coughing up blood.
• Remove extra mucus, foreign objects, or anything else blocking the airways.
• Find out how advanced someone’s lung cancer is and monitor the cancer during treatment.

Why Is Bronchoscopy Performed?

A doctor will suggest a bronchoscopy if he or she needs to see inside your airways or remove something from them. Knowing the condition of your airways helps the doctor prescribe the right treatment, so you can start breathing better.

This procedure is often used to help diagnose diseases like asthma, lung cancer, bronchitis, and bronchiectasis.

The doctor can use a bronchoscope to take small pieces of tissue for lab tests. He or she can also remove extra mucus, foreign objects, or other things blocking the airway.

Reasons to perform a bronchoscopy include:

• Persistent cough
• Difficulty breathing (dyspnea)
• Coughing up blood (hemoptysis)
• Abnormal chest x-ray
• Inhalation of a foreign object

Are There Any People Who Shouldn’t Have Bronchoscopy?

Conditions that may prevent someone from having a bronchoscopy include:

• Unstable low blood pressure (hypotension)
• Low cardiac output (the amount of blood your heart pumps)
• Irregular heartbeat (arrhythmia)
• Recent heart attack or heart disease
• Bleeding problems
• Severe anemia (a low level of red blood cells)
• Allergy to lidocaine (an anesthetic medication)

Getting Ready For Bronchoscopy

Before the bronchoscopy (usually a day or two before), the doctor will usually test your blood and urine. You may also need to have a chest x-ray or CT scan. A CT scan is a painless, sophisticated x-ray procedure that uses a computer to provide images of soft tissue, bone, and blood vessels.

Tell your doctor:

• If you are allergic to any medicines, especially anesthetics such as lidocaine.
• What medicines you take, especially Coumadin^TM or daily aspirin. He or she may want to adjust the amount or timing of your medication the day of the bronchoscopy.
• If you have insulin-dependent diabetes.
• Whether you have ever had problems with bleeding or blood clots.

Before the procedure:

• For a week before the procedure, do not take aspirin, ibuprofen (such as Advil), or Coumadin^TM. These medications thin the blood and can cause bleeding problems during the procedure.
• Don’t eat or drink anything after midnight the night before surgery. You can take medicine that has been approved by your doctor with a small sip of water. Take the medicine at the time your doctor suggests.
• Get special instructions from the doctor if you have diabetes.
• Arrange for someone to drive you home after the bronchoscopy, because you may be drowsy.

Preparing Your Child For Bronchoscopy

Bronchoscopy is very safe in children. It’s usually done under general anesthesia, but your child can go home the same day.

What Happens During A Bronchoscopy?

Most people are awake during this procedure. You will have medicine to help you relax and to numb your throat. The bronchoscopy itself usually takes about 20 minutes.

This is what usually happens during bronchoscopy:

• First, you’ll take medicine to help you relax. A nurse will start an IV (intravenous) needle in your arm. The IV allows the doctor to give you extra medicine if you need it during the procedure.
• The nurse will give you extra oxygen through your nose. He or she will also connect you to machines that monitor your heart, blood pressure, and the amount of oxygen in your blood.
• The doctor will spray a local anesthetic into your mouth or nose, or may inject anesthesia under your chin to numb your voice box. The medication may make you cough for a short while.
• The doctor will gently slide the thin bronchoscope tube into your mouth and nose. If it goes through your mouth, you’ll hold a plastic mouthpiece (the “bite block”) between your teeth. That keeps you from biting the tube.
• You might feel a little out of breath as the tube passes your vocal cords. The doctor will stop to let you catch your breath.
• Don’t talk during the procedure. Talking can make you hoarse and make your throat sore afterward.
• The doctor will look through the tube into your airways. He or she might use tools inside the tube to collect mucus, cells, or tissue samples (a biopsy) from your lungs or airways. You might feel a slight tug when the tissue is removed.
• Sometimes the doctor will put a saline solution (that is, salt water) through the bronchoscope, then gently suck it back out. This is called a bronchoalveolar lavage (BAL). It helps collect cells that can be used to diagnose your disease. Sometimes lavage is used to remove extra mucus.

If your doctor is using a rigid bronchoscope, you’ll probably receive general anesthesia and will be asleep during the procedure.

If you stayed awake during the bronchoscopy, you’ll have a chance to rest after the procedure.

• Tell the doctor or nurse if you have chest pain or difficulty breathing.
• Don’t eat or drink anything until the local anesthesia wears off, because you could choke. It usually takes two to four hours for the gag reflex to come back.

If you received general anesthesia and were asleep for the bronchoscopy:

• You will stay in the recovery room until you are fully awake and able to move around.
• If the doctor took a biopsy, you may have a chest x-ray afterward to make sure your lung was not damaged.

What Happens After A Bronchoscopy?

Bronchoscopy does not usually cause any complications. For the first day or so, you might have these symptoms:

• Mild fever (less than 101 degrees F, 38.3 degrees C)
• Hoarseness
• Coughing up small amounts of blood (less than a tablespoon)

You can take acetaminophen (such as Tylenol) or ibuprofen (such as Advil) for these symptoms.

Avoid vigorous exercise for the first week after surgery. You can go back to your other activities as soon as you feel ready.

Are There Any Risks To Bronchoscopy?

Bronchoscopy is a safe procedure. Complications are rare and may include:

• Collapsed lung (pneumothorax)
• Continued bleeding from the place where a tissue sample was taken
• Allergic reaction to one of the medicines
• Fever
• Abnormal heart rhythm
• Spasms of the airways or voice box (larynx)

Bronchoscopy is more likely to cause a problem in people with these conditions:

• Severe chronic obstructive pulmonary disease (COPD)
• Uncontrolled asthma
• Heart disease
• Pneumonia
• Advanced neoplasia (abnormal cell growth)

Follow-Up Care After Bronchoscopy

Bronchoscopy does not require follow-up care or rehabilitation. If the doctor has obtained enough information to diagnose your breathing problem, you can start treatment right away.

Occasionally, people need a more invasive procedure such as:

• Needle biopsy (thoracentesis), in which the doctor uses a needle to remove fluid from the space around the lungs
• Mediastinoscopy, a procedure in which a doctor inserts a small, lighted tube through an incision at the base of the throat in order to see inside the chest
• Thoracoscopy, a procedure in which a doctor inserts instruments through several incisions in the chest or under the arm
• Surgical lung biopsy, in which tissue from the lungs is removed through a surgical procedure

Frequently Asked Questions: Bronchoscopy

Here are some frequently asked questions related to bronchoscopy.

Q: Does bronchoscopy hurt?

A: No one’s going to say bronchoscopy is particularly comfortable, but it shouldn’t hurt. If you’re worried, work out a hand signal with your doctor ahead of time. You can raise your hand to tell him or her to stop putting in the bronchoscope until you can catch your breath and relax a little.

Q: Why should I have bronchoscopy instead of an x-ray?

A: Bronchoscopy allows the doctor to see inflammation (red, swollen tissue), abnormal cells, and bleeding that don’t show up on x-rays. It also has less risk and causes less pain than alternatives like surgical biopsy. The bronchoscope lets the doctor look directly at your airways, so he or she gets better information and you have to go through fewer tests.

Q: What’s the downside to bronchoscopy?

A: It’s not as quick or comfortable as imaging techniques such as CT scans. Also, bronchoscopy may not be able to get a tissue sample large enough – or from deep enough in the lung – to diagnose certain diseases.

Q: Will my regular doctor do the procedure?

A: That depends on the doctor. Sometimes your physician will refer you to a specialist who has more experience using the bronchoscope.

Q: Is this procedure done in a hospital?

A: Bronchoscopy is usually performed in an outpatient center at a hospital. Sometimes your doctor will send you to a day surgery center that specializes in outpatient procedures. Nearly all people will go home the day of the procedure, without an overnight hospital stay.

Putting It All Together: Bronchoscopy

Here is a summary of the important facts and information related to bronchoscopy.

• Bronchoscopy lets the doctor see inside your airways, using a thin tube called a bronchoscope. The tube uses fiberoptics or a tiny video camera to produce images of the airways.
• Doctors perform bronchoscopies to help diagnose diseases or remove something blocking the airways. If you have been coughing up blood, bronchoscopy can show where it is coming from.
• Sometimes a doctor uses the bronchoscope to take a little piece of tissue (a biopsy) from your airways. Looking at that tissue under a microscope can help diagnose the cause of your breathing problem.
• Bronchoscopy is usually an outpatient procedure and is considered very safe.
• Someone having a bronchoscopy should not eat or drink anything for at least eight hours before the procedure.
• The procedure itself only takes about 20 minutes, but plan to be at outpatient surgery center or hospital for three or four hours.
• Most people feel fine after this procedure. Some people are hoarse, have a mild fever, or cough up small spots of blood afterward.
• If you cough up a lot of blood, have a high fever, or have trouble breathing after a bronchoscopy, call your doctor right away.

Glossary: Bronchoscopy

Here are definitions of medical terms related to bronchoscopy.

biopsy: A procedure to remove a small piece of tissue from part of the body for examination under a microscope. “Biopsy” can also mean the tissue sample itself.

bronchial tubes, bronchi: The tubes that carry air from the throat (trachea) into the lungs. The larger bronchial tubes branch into smaller bronchioles that reach the air sacs (alveoli). All the bronchi together are sometimes called the “bronchial tree.”

bronchiectasis: Damaged, stretched bronchial walls. It can be a congenital condition (one you’re born with), but it usually results from infection, a tumor, or inhaling a foreign object.

bronchoalveolar lavage (BAL): A procedure that uses the bronchoscope to send water (sterile saline solution) into the bronchioles and air sacs. The bronchoscope then sucks the water back out. Doctors can examine cells and mucus removed this way to diagnose diseases. Sometimes BAL is used to clear extra mucus or other secretions from the lungs.

chronic obstructive pulmonary disease (COPD): Breathlessness that gets continually worse over time. The term includes chronic breathing problems from several different causes, including emphysema, chronic bronchitis, asthma, or chronic bronchiectasis. COPD cannot be cured.

dyspnea: Breathlessness, shortness of breath, difficulty breathing.

Fiberoptics: Glass or plastic fibers that transmit light and images. Fiberoptics are used in bronchoscopes, laparoscopes, endoscopes, and similar medical tools.

hemoptysis: Coughing up blood from the lungs or airways.

pleura: The lining around the lungs.

pneumothorax: Air in the space around the lung that causes the lung to collapse.

tuberculosis: A disease caused by infection with bacteria that can affect almost any tissue or organ of the body, the most common location being the lungs.

Additional Sources Of Information: Bronchoscopy

Here are some reliable sources that can provide more information on bronchoscopy.

American Lung Association

http://www.lungusa.org

1-800-LUNG-USA

A good site for easy-to-understand information about many different lung diseases. It doesn’t have any information on bronchoscopy itself, though. After getting a diagnosis, come here to find out more about treatment and prevention.

The Virtual Hospital, a service of the University of Iowa School of Medicine

http://www.vh.org

U.S. National Library of Medicine

http://www.nlm.nih.gov/