Bronchoscopy

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What is Bronchoscopy? 

Bronchoscopy is a test conducted to view the airways and diagnose lung problems. 

A bronchoscopy allows a doctor to examine the airways and the lungs using an instrument called a bronchoscope. The thread-like instrument is passed through the nose or mouth, and down the throat to reach the lungs. The bronchoscope which is made of a flexible fibre-optic material also has a light source and a camera on the end. Most bronchoscopes are designed to be compatible with a colour video, which helps the doctors document their findings. It’s usually performed by a pulmonologist, a doctor who specializes in lung disorders. 

Usually, bronchoscopy is commonly performed with a flexible bronchoscope. However, in some situations, whereby there’s a lot of bleeding in the lungs or a large object is stuck in the airway, a rigid bronchoscope may be desirable.

Bronchoscopy is usually required when there are a persistent cough, infection or when something uncommon is seen on a chest X-ray or other test. It can also be used to acquire samples of mucus or tissue, to remove foreign bodies or other blockages in the airways or lungs, or in treating lung problems.

Why bronchoscopy is done?

A bronchoscopy procedure can be used to diagnose several conditions such as

• Lung disease.
• Bronchial cancer or tumours.
• Chronic cough.
• Airways strictures and obstructions.
• Infections. For example tuberculosis, pneumonia, and fungal or parasitic lung infections.
• Inflammation.
• Vocal cord paralysis.
• Interstitial pulmonary disease.
• Abnormal chest X-ray or CT scan.
• Tissue biopsy from the lung.

It can also be used in certain treatment method, such as

• Stent: Placement of a small tube to hold open an airway.
• Treatment of lung problems, which includes bleeding, an abnormal narrowing of the airways (that is, stricture), or a collapsed lung (that is, pneumothorax).
• Laser therapy or radiation treatment for bronchial tumours.
• Abscess.

Types of bronchoscopy

A bronchoscopy procedure is of two types – flexible bronchoscopy and rigid bronchoscopy. Both of which comes in different widths.

Rigid bronchoscopy: this bronchoscopy procedure is a straight tube, used only to view the larger airways. Rigid bronchoscopy can be used within the bronchi to;

• Take out a large number of secretions or blood.
• Control bleeding.
• Take out foreign objects.
• Take out lesions (diseased tissue).
• Carry out procedures, such as stents.

Flexible bronchoscopy: this bronchoscopy procedure is used more often. Unlike rigid bronchoscopy procedure, the flexible bronchoscopy procedure can be moved down into the bronchioles (smaller airways). A flexible bronchoscopy procedure may be used to:

• Place a breathing tube into the airways to help supply oxygen.
• Suck out secretions.
• Bronchoscopy biopsy (collect tissue samples).
• Supply medicine to the lungs.

Preparation for a bronchoscopy procedure. 

This begins with positioning. The patient is positioned to sit or lie on the back on a table or a bed with the arms by the sides. The patient will then be connected to monitors to enable the health care team to track the heart rate, blood pressure and oxygen level during the procedure.

A sedative is also given intravenously to help patients relax. This causes sleepiness, but patients will still be awake and conscious, breathing on their own and being able to respond to questions that may asked during the procedure.

Anaesthesia will also be sprayed in the throat, and sometimes an anaesthesia gel is rubbed in the nose. These medications numb the areas to lessen gagging and coughing as the bronchoscope is inserted into the throat. You may have to avoid food or drink consumption for 6 to 12 hours before the bronchoscopy procedure.

Bronchoscopy procedure. 

During the bronchoscopy procedure, the bronchoscope is inserted in the nose or mouth. With the aid of the light and the small camera fitted at the tip of the bronchoscope, it is able to display pictures on a monitor. This helps guide the doctor in performing the bronchoscopy procedure.

The bronchoscope is then gently advanced slowly down the back of the throat, through the vocal cords and finally into the airways. It may feel a bit uncomfortable, but it usually doesn’t hurt.

Bronchoscopy results. 

A bronchoscopy result can be either of two – normal or abnormal bronchoscopy result.

Normal bronchoscopy results mean that no foreign materials, blockages, or unusual cells or fluids were seen in the bronchi.

Abnormal bronchoscopy results indicate one or more of the following issues:

• Bacterial, viral, fungi or parasitic infection.
• Inflammation of the lung tissue.
• Damages to the lungs.
• Cancer of the lungs or the areas between the lungs.
• Contraction of the trachea or bronchi.
• Rejection of a transplanted lung.

The doctor may probably recommend further tests or treatments. It all depends on the outcome.

FAQs 

What are the likely bronchoscopy risk and complications?

The main bronchoscopy risks are:

• Bleeding at the biopsy sites, and
• Infections.

Other bronchoscopy risks include;

• Abnormal heart rhythms.
• Breathing difficulties.
• Fever.
• Possible heart attack in those with existing heart disease.
• Low blood-oxygen level.
• Collapsed lung: as a result of accidental damage to the airways.
• Sore throat.

When general anaesthesia is used, a couple of bronchoscopy risk and complications could occur. These include;

• Muscle pain.
• Alteration in blood pressure.
• Slow heart rate.
• Nausea and vomiting.

What types of imaging are used in a bronchoscopy?

Sometimes to get a more detailed picture of the inside of the lungs, advanced forms of imaging are used in conducting a bronchoscopy procedure. These include

• CT scans, to see the airways in more detail. This can be sued during a virtual bronchoscopy.
• An ultrasound probe can also be attached to a bronchoscope to view the airways. This can be used during an endobronchial ultrasound.
• A fluorescent light to see the inside of this lungs. This is used during a fluorescence bronchoscopy.

What happens after a bronchoscopy procedure?

A bronchoscopy procedure is relatively quick. Lasts about 20 to 40 minutes. Due to the sedation, a hospital stay is required for a couple of hours and until the patient feels more awake and the numbness in the throat wears off. Breathing pattern and blood pressure will also be monitored during this recovery period.

There shall be no food or fluid consumption until the throat stops numbing, and this can take about one to two hours. The throat is likely to feel sore or scratchy for a couple of days, and the voice might be hoarse. This is absolutely normal. It usually doesn’t last long and wears off without taking medication or any treatment.

How is recovery from a bronchoscopy procedure like?

Recovering from a bronchoscopy is relatively quick. Cough reflex (that is, the ability to cough) returns within 2 hours. After which, it becomes safe to eat and drink. 

Return to regular activities occurs after 24 hours of a bronchoscopy procedure. But sore throat and hoarseness may last for a few days. This is normal.