Patient education: Diagnostic bronchoscopy (The Basics)

What is a diagnostic bronchoscopy? — A bronchoscopy is a type of procedure done to look at the airway and lungs. "Diagnostic" means that it is being done to check for the cause of a problem.

Bronchoscopy is done with a special tool called a "bronchoscope" (figure 1). This is a thin tube with a camera on the end. It is inserted through the nose or mouth. There are 2 types of bronchoscopes:

●Flexible – This type bends easily.

●Rigid – This type is more stiff.

Most diagnostic bronchoscopies are done with a flexible bronchoscope.

Your doctor might want you to have a diagnostic bronchoscopy to:

●Check for an infection

●Check for lung disease or lung problems like a blocked airway

●Do a biopsy – For a biopsy, the doctor takes a small sample of tissue. Then, the sample is looked at under a microscope.

●Get a sample of fluid or mucus for testing

●Look for the cause of problems like coughing up blood, cough lasting longer than 8 weeks, wheezing, or hoarseness

●Look for an object that might have been inhaled by accident, like a piece of food or gum

●Check your airways after a lung transplant

Bronchoscopy is usually done by a type of doctor called a "pulmonologist." Pulmonologists focus on the airway and lungs.

How do I prepare for my bronchoscopy? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Imaging tests – These create pictures of the inside of the body.

●Lab tests

●Electrocardiogram ("ECG") – This test measures the electrical activity in your heart.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In most cases, you might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure.

●What help you will need when you go home – You will need to have someone else bring you home. You might also need someone to stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a bronchoscopy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia is used to numb your throat or nose, where the bronchoscope will be inserted.

•Sedatives – These will make you relax and feel sleepy during the procedure. They will also make it so you don't remember the procedure.

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, oxygen level, and heart rate during the procedure.

●The doctor will slowly insert the bronchoscope through your nose or mouth (figure 1). The camera on the end sends pictures to a screen that the doctor can see.

●If the doctor needs to take a sample of tissue or fluid for testing, they will do this. They will use a special wire that is inserted through the bronchoscope. In some cases, the doctor might use imaging to make sure that they are taking samples from the right place.

What happens after a bronchoscopy? — After your procedure, the staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●The staff will help you get out of bed and start moving around when you are ready.

●The staff will monitor you to decide when it is safe for you to start eating and drinking again. This is because it can take a few hours for your "gag reflex" to return. When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

●You might have a sore throat or nose for a day or so after your procedure.

●If you had a biopsy, you might cough up a little bit of blood after the procedure.

●In some cases, your doctor might want you to have a chest X-ray after your bronchoscopy.

Depending on the results of your bronchoscopy and any other tests you had, you might need more testing or treatments. Your doctor will talk to you about what happens next.

What are the risks of bronchoscopy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Damage to the lung or airways

●Fever – Some people get a slight fever for a short time after bronchoscopy. This does not always mean that you have an infection.

●Low blood pressure and fainting – This could be caused by the sedative medicines. It usually does not last long.

●Abnormal heart rhythm – This usually does not last long. The heart typically goes back to a normal rhythm without treatment.

●Not getting enough oxygen or having trouble breathing during the procedure – If this happens, the medical team can give you more oxygen to help, or they might stop the procedure.

What problems should I watch for at home? — It is not likely that you will have problems after a bronchoscopy. But you should still watch for the following problems for a few days after you go home.

Call for an ambulance (in the US and Canada, call 9-1-1) if you:

●Suddenly start having trouble breathing

●Cough up a lot of blood

●Have chest pain or tightness

Call your doctor or nurse for advice if you have:

●Signs of an infection. These include:

•Fever of 100.4°F (38°C) or higher

•Chills

•Very bad sore throat

•Cough

•More sputum than usual or a change in sputum color – Sputum is a mixture of saliva (spit) and mucus that is coughed up from the lungs.

●Cough or shortness of breath

●Very bad nausea or vomiting

●Wheezing that is not normal for you

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