Bronchoscopy

Your lungs are made up of air sacs and tubes that lead to these air sacs. The tubes that lead to the air sacs are called bronchi or bronchioles. The tubes and the air sacs together are called the ‘airways’ of your lungs. 

A bronchoscopy is a procedure that lets a doctor look inside your lung's airways. It is used to help diagnose certain lung conditions.

To see the inside of your lungs, a bronchoscopy uses a bronchoscope. A bronchoscope is a thin flexible tube with a light and a camera that is passed slowly and gently into your lungs so doctors can get a clear view of the airways in your lungs. Your airway can be seen in real time, and pictures can be taken to look at later. Some overseas clinics are developing robotic bronchoscopes whereby a robotic bronchoscope is guided into your airways. Some bronchoscopes are larger and more rigid. 

Special devices can be passed through the bronchoscope, such as: 

• a device to remove objects stuck in the airway 
• a tiny ultrasound probe to scan tissues and lymph nodes around your lungs 
• a cauterising device to seal off and stop bleeding 
• a device to take a biopsy of a tumour or of mucous or a blockage 
• a laser to reduce or treat a tumour 
• a tube or stent to open up a constricted area of your airway. 

Image credit: Canva

A bronchoscopy is often done after a chest X-ray or a CT scan that has shown something abnormal in your lungs.

Th bronchoscopy can also be used to diagnose conditions close to your lungs, such as tumours in lymph glands in your chest area. It can also be used to help treat a lung problem. You may have a bronchoscopy done as a planned procedure to look at the inside of your lungs or examine the tissues around your lungs, or you may have one done urgently if you have a sudden problem with your lungs. 

You might need a bronchoscopy if you have lung problems such as:

• persistent cough 
• difficulty breathing 
• a collapsed lung 
• a blocked airway – with an object, a piece of food, a plug of mucous or a tumour 
• bleeding in the lung 
• a tumour in the lung 
• suspected tumours around the outside of your lung.   

 If you are a child needing a bronchoscopy it is most often to: 

• remove an object blocking your airway when you have choked 
• wash away secretions in your lungs 
• take a sample of tissue from your lungs if you have had a persistent cough. 

You will be asked not to eat or drink anything for 4–6 hours before the bronchoscopy. If you have diabetes check with your diabetes team to get help with managing your diabetes through this time.  Your bronchoscopy is normally done in a hospital service or private clinic.   

If possible, arrange for someone to drive you home after the bronchoscopy. You will have had sedation and so it will not be safe for you to drive for around 12 hours after your bronchoscopy.  If you live alone you may want to ask a  friend or member of your whānau to stay overnight with you afterwards.

Your actual bronchoscopy will usually take 30–60 minutes, but allow around 4–6 hours for the whole process including preparation and recovery time. When you arrive you will talk to a nurse or doctor who will explain the process to you. You will change into a hospital gown and an IV cannula will be placed in your arm. This is so you can have a sedative before the bronchoscopy is done. 

Most bronchoscopies are done under sedation, but occasionally you may need to have a general anaesthetic for your bronchoscopy. If this is the case you will be fully prepared for an anaesthetic. See here for more information on anaesthesia.

A local anaesthetic will be sprayed into the back of your throat to make it numb. You will usually be given a sedative through the IV cannula in your arm. This will mean that although you are awake for the bronchoscopy, you will be relaxed and calm. Nurses and doctors will stay with you to make sure that you remain well and safe throughout the bronchoscopy.   

The doctor doing the bronchoscopy will then pass the bronchoscope through your mouth and into your airways. You will be able to breathe and swallow throughout the process. This part of the process usually takes around 15–20 minutes. 

After the bronchoscopy has been done you will rest in a recovery area. It will take some time for the sedative to wear off.  Once you are awake enough and can swallow well you will usually be given a light meal. You may have a chest X-ray taken after your bronchoscopy if a sample has been taken of your lung or a stent or tube inserted. 

Follow the instructions given to you by the team doing your bronchoscopy. Take the rest of the day to rest quietly at home. It is important that you do not drive because you have had a sedative. You should be able to work and do your normal activities the following day. Your voice may be hoarse and you may have a sore throat for several days. Don't drink iced water as this can cause you to cough.

Note: You may cough up a small amount of blood, but if it is more than a few tablespoons seek urgent medical advice or go to the emergency department straight away.    

Seek medical help straight away if: 

• you are coughing up blood and it is more than 2 tablespoons or it is not settling 
• you have chest pain 
• you are having trouble breathing 
• you have a fever that lasts more than 24 hours. 

View an animation of a bronchoscopy.(external link)(external link)

Bronchoscopy is usually a safe procedure. You may be hoarse and have a sore throat after the procedure. There's a slight risk of minor bleeding or developing a fever or pneumonia. A rare, but more serious risk is a collapsed lung or pneumothorax. In this condition, air collects in the space around the lungs, which causes one or both lungs to collapse. If this happens you will need urgent hospital treatment.