Fiberoptic bronchoscopy is a procedure that allows a clinician to examine the breathing passages (airways) of the lungs. Fiberoptic bronchoscopy can be either diagnostic, to find out more about a possible problem, or therapeutic, to try to treat an existing problem or condition.
Reasons for Bronchoscopy
- Unexplained symptoms: persistent cough, coughing up blood, wheezing, hoarseness, noisy breathing, or shortness of breath.
- Persistent lung collapse (atelectasis) to rule out or confirm an obstruction. If possible, the clinician removes the cause of the obstruction to open the airways. Biopsies of abnormal tissue may be taken.
- Abnormal chest x-ray may suggest problems that require closer inspection with bronchoscopy. In most cases, fluid samples or a biopsy are obtained to look for signs of infection, cancer, or inflammation.
Sedation and anesthesia
Bronchoscopy can be done in a special procedure suite. In most cases, intravenous (IV) sedative medications are given before the procedure to induce drowsiness and relaxation. These medications often cause the person to forget what happened during the procedure. In the procedure area, the patient will be connected to a pulse oximeter to monitor the blood oxygen level. Blood pressure and heart activity are also monitored.
The back of the throat will be treated with a local anesthetic spray. This helps to prevent coughing and gagging during the procedure. However, the local anesthetic often has a bad taste.
During bronchoscopy, a thin flexible tube called a bronchoscope is placed in the nose or mouth. The bronchoscope has a very small camera at its tip that displays pictures on a video screen. The bronchoscope will be placed into either the nose or the mouth, then advanced slowly down the back of the throat, through the vocal cords and into the airways. Some people have an urge to cough or feel a sensation of wanting to catch their breath. If there is significant discomfort, more anesthesia can be given. Once the bronchoscope has passed between the vocal cords, it is difficult to speak normally. This can be frightening, but it is expected and is resolved when the bronchoscope is removed. Oxygen levels are monitored at all times to be sure that the patient is getting enough air.
Examination starts with an airway inspection. In some cases, samples of tissue and fluid are taken using devices passed through the bronchoscope.
Bronchoscopy is a safe procedure. Complications are infrequent and usually minor. Complications may be related to the procedure itself or to adverse reactions caused by sedatives or numbing medicines.
Bleeding can occur, especially if a biopsy is taken during the procedure. It is usually minor and stops without treatment. Rarely, bleeding can lead to severe breathing problems requiring a breathing tube or need for surgery.
Fever and infection
Fever is relatively common after bronchoscopy but is not always a sign of infection.
Myocardial ischemia refers to a strain on the heart muscle caused by insufficient blood flow to the coronary arteries. This is a rare complication but we recommend delaying bronchoscopy for six weeks after a heart attack, if possible.
The oxygen level in the patient's blood is monitored continuously during bronchoscopy and may fall briefly during the procedure. This drop is usually mild, and the level usually returns to normal without treatment. Extra oxygen may be given to maintain a safe level of oxygen in the blood.
Lung leak or collapse
Infrequently, the airway may be injured during bronchoscopy, particularly if the lung is significantly inflamed or diseased. If the lung is punctured, it can cause an air leak (pneumothorax), which results in lung collapse. This complication is more likely if a biopsy is taken during the procedure. If there is a large or ongoing air leak, it may need to be drained with a small tube placed into the chest between the ribs. This complication may require overnight hospitalization. Leaks usually heal spontaneously, allowing removal of the drainage tube within one or two days.
Care Following the Procedure
Patients will be monitored closely for two to four hours after bronchoscopy. Eating and drinking is not allowed until the effects of the anesthesia have worn off and a normal gag reflex has returned. A chest x-ray will be performed if a lung biopsy was taken to check for signs of a pneumothorax. Patients who develop complications may need to stay in the hospital overnight. Patients who return home on the day of the procedure must not drive an automobile or operate heavy machinery, because of the lingering effects of sedation. A family member or friend must be available to drive or accompany the patient home.
Once at home, the patient may have a mild sore throat, hoarseness, cough, or muscle aches. This is normal. However, a patient should get help immediately if there is increasing chest pain or shortness of breath, or if more than a few tablespoons of blood are coughed up . Fever (temperature greater than 100.4ºF or 38ºC) is common after bronchoscopy, but usually lasts for only for 24 hours. If fevers persist for longer than one day, the patient should contact their physician.
Preliminary results about the overall appearance of the airways are usually available immediately after bronchoscopy. Results of any biopsies or other tests take 5 business days and the patient and/or referring physician will be called with results.