Bronchoscopy
Bronchoscopy
by Elissa Sonnenberg, MSEd
Anatomy and Physiology
The mouth and nose provide points of entry so that air can travel in and out of the lungs through the windpipe, known as the trachea, and bronchial tubes.
 With each breath, the lungs take fresh oxygen from the air into the blood and remove leftover carbon dioxide from the blood for exhalation.
Reasons for Procedure
To see and diagnose problems inside the lungs, a doctor may examine its major airways by performing a bronchoscopy. This procedure allows your doctor to see inside the trachea and larger bronchial tubes, remove foreign bodies or excess mucus, and/or obtain tissue samples, known as biopsies, for laboratory examination.
A bronchoscopy may be done to: look for, and possibly retrieve, a foreign object that might have been inhaled instead of swallowed, investigate a persistent cough or a cough producing blood, obtain a mucus, tissue, or liquid sample from inside the lungs, or evaluate an abnormal chest x–ray or CT scan.
Treatments
During a bronchoscopy, your doctor will insert one of two types of bronchoscopes, through your nose or mouth and into your trachea and bronchial tubes. The bronchoscopes consist of lighted, flexible tubes that carry image equipment and other instruments. Your doctor will choose which type of bronchoscope to use based upon your symptoms.
A fiberoptic bronchoscope can pass through your nose or mouth. It projects a magnified image of lung tissue on a screen and can collect small samples. An open tube bronchoscope is slightly thicker and must pass through your mouth. It can remove foreign objects or collect larger samples for biopsy.
Procedure
In the days leading up to your procedure: Do not take aspirin or other over–the–counter pain medication, unless told otherwise by your doctor. If you take blood thinners or drugs that affect the blood platelets, discuss with your doctor how to take those medications. Arrange for a ride to and from the hospital and for help at home as you recover. The night before the procedure, eat a light meal and do not eat or drink anything after midnight.
A bronchoscopy is generally an outpatient procedure, so you should plan to be discharged on the same day. Before the bronchoscopy begins, you will receive medication to help you relax and minimize coughing. You will have an intravenous line inserted for additional medications. Your heart and blood pressure will be monitored and you will be given extra oxygen during the procedure.
 A bronchoscopy, which usually takes less than an hour, requires either a local anesthetic to numb your throat or general anesthesia. If your doctor uses a local anesthetic, you can help relieve the urge to cough during the procedure by taking slow, shallow breaths through your mouth.
 Your doctor will slowly thread the bronchoscope through your nose or mouth, down your throat, past your vocal cords, through your trachea and into the bronchial tubes. He or she will carefully examine the lining of your airways and may take samples for laboratory examination, or remove a foreign object.
Risks and Benefits
Most patients who undergo a bronchoscopy have a sore throat after the procedure. Other, less common complications include: significant bleeding at the site of the tissue sample, if your doctor takes a biopsy, collapsed lung, irregular heart rhythm, which is a greater risk if you have a pre–existing heart condition, infection, chipped tooth, although this is rare if your doctor uses a fiberoptic bronchoscope.
Benefits of bronchoscopy include: accurate diagnosis of lung conditions without the need for chest surgery, and/or removal of foreign objects or mucus from the airway.
In a bronchoscopy, or any other procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it’s the most appropriate treatment choice for you.
After the Procedure
After your bronchoscopy, you will be taken to a recovery area. If a biopsy has been taken, you will likely have a chest x–ray before you leave the hospital. Your doctor will send any mucus, liquid, or biopsy samples removed from your lungs to a laboratory for examination, the results of which should be available within a week.
After your bronchoscopy, you will be asked to: spit out saliva and try not to swallow as long as your throat muscles remain numb, refrain from driving until the sedative has worn off completely, wait two hours before attempting to eat or drink anything, start with sips of water and slowly progress to solid food, resume taking your usual medications and diet as instructed by your doctor.
Once you are home, be sure to contact your doctor if you experience: signs of infection, including fever and chills, although a slight fever alone is common after a bronchoscopy, a cough that brings up more than a teaspoon of blood, shortness of breath, chest pain or persistent cough, and/or severe nausea or vomiting.
Sources:
Bronchoscopy. Medline Plus Medical Encyclopedia. U.S. National Library of Medicine and the
National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/
article/003857.htm. Accessed August 12, 2004.
Bronchoscopy Patient Education Guide. American College of Chest Physicians website.
Available at: http://www.chestnet.org/education/patient/guides/bronchoscopy/index.php.
Accessed August 12, 2004.
Informed Consent form for Bronchoscopy. Queensland Government website. Available at:
http://www.health.qld.gov.au/informedconsent/ConsentForms/medical/bronchoscopy.pdf.
Accessed August 12, 2004.
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