Bronchoscopy

Bronchoscopy is a procedure in which a doctor passes a thin, flexible tube with a camera on its tip through your nose or mouth, down your throat, and into your airways to look directly inside your lungs.

Once the tube is inside the airways, the camera sends live images to a screen so the doctor can inspect the lining of the bronchi (the main air passages that branch off from the windpipe). If something unusual is found — such as a blockage, abnormal tissue, or mucus — the doctor can take a small sample, clear the obstruction, or deliver treatment through the same tube during the same visit.

Bronchoscopy is used when a doctor needs a direct view of the airways or lungs that cannot be obtained from imaging alone, or when a tissue sample or targeted treatment is needed.

• A persistent cough that does not improve or has no clear cause
• Coughing up blood (haemoptysis)
• A shadow or mass seen on a chest X-ray or CT scan that needs further investigation
• Suspected lung infection, including tuberculosis (TB) or pneumonia that has not responded to treatment
• Narrowing or blockage of an airway (stenosis)
• Foreign body — an object accidentally inhaled into the airway
• Collection of fluid or pus around the lungs that needs drainage
• Checking the airways before or after a lung transplant
• Placing or checking a stent (a small tube that props an airway open)

Bronchoscopy is usually not suitable in certain situations, and your doctor will assess your fitness carefully beforehand.

• Severe breathing difficulty that makes it unsafe to partially narrow the airway during the procedure
• Very low oxygen levels that cannot be stabilised before the procedure
• A serious clotting disorder or use of blood thinners that has not been managed — this raises the risk of bleeding from any sample taken
• Recent heart attack or unstable arrhythmia (an irregular heartbeat)
• Known severe allergy to the anaesthetic agents used for the procedure

Bronchoscopy is generally considered a safe procedure, but like any medical intervention it carries some risks, which are more likely if a tissue sample or therapeutic treatment is carried out at the same time.

• Sore throat or hoarse voice after the tube is removed — this is the most common effect and usually settles within a day or two
• Mild fever in the hours after the procedure
• Bleeding at the site where a biopsy (tissue sample) was taken — usually minor and self-limiting
• Low oxygen levels during or shortly after the procedure, requiring extra oxygen support
• Bronchospasm — a sudden tightening of the airway muscles that causes wheezing or shortness of breath
• Pneumothorax (a collapsed lung) — a small pocket of air that leaks outside the lung; this is uncommon but is monitored with a chest X-ray after the procedure
• Infection introduced by the procedure — minimised by strict sterile technique
• Reaction to the sedative (calming medicine) or local anaesthetic (numbing medicine) used
• Rarely, significant bleeding requiring further treatment if a large biopsy or therapeutic procedure was performed

Preparing carefully helps the procedure go smoothly and reduces the chance of complications. Your care team will give you specific instructions, but the following covers what is typically expected.

Fasting and lifestyle adjustments: You will usually be asked to stop eating and drinking for several hours before the procedure — your team will tell you the exact cut-off time. Smoking should be avoided in the days leading up to bronchoscopy because it irritates the airways and increases mucus. Alcohol should also be avoided for at least a day before, as it can interact with sedative medicines used during the procedure.

Medicines: Tell your doctor about every medicine you take, including supplements and herbal remedies. Blood thinners and certain other medicines are usually paused before the procedure to reduce the risk of bleeding. Your doctor will decide which medicines to pause and for how long. Do not stop any medicine on your own without guidance.

Tests beforehand: To make sure you are safe for the procedure, your doctor will usually arrange some or all of the following:

• Blood tests to check clotting ability and overall health
• A chest X-ray or CT scan if not recently done
• Lung function tests (spirometry) to measure how well you breathe
• An EKG (electrocardiogram) to check your heart rhythm, especially in older patients or those with heart conditions
• Oxygen saturation measurement using a small clip placed on your finger

What happens during the procedure — a typical sequence:

• 1. You are positioned on a bed or reclining chair, usually lying on your back.
• 2. A numbing spray or gel is applied to your nose or throat to reduce discomfort.
• 3. A sedative is given through a small tube (cannula) placed in a vein in your arm, so you feel relaxed and drowsy — most patients remain awake but calm.
• 4. Oxygen is provided through a small clip or mask throughout the procedure.
• 5. The bronchoscope (the flexible camera tube) is gently guided through your nose or mouth, past your vocal cords, and into the main airways.
• 6. The doctor inspects the airway walls, looking for anything abnormal.
• 7. If needed, a tiny brush or forceps is passed through the bronchoscope to collect a biopsy (tissue sample), or a saline (salt water) wash called bronchoalveolar lavage (BAL) is used to collect cells from deep in the lung.
• 8. If the purpose is therapeutic — such as removing a foreign body, clearing a mucus plug, or placing a stent — the appropriate tool is used through the bronchoscope.
• 9. Once the examination or treatment is complete, the bronchoscope is carefully withdrawn.
• 10. You are moved to a recovery area and monitored until the sedative wears off.

After bronchoscopy, you will be kept under observation until the sedative has worn off and your oxygen levels are stable. Most patients go home the same day, though this depends on what was done during the procedure and your overall health.

• Monitoring: Your oxygen levels, breathing, and pulse are checked regularly in the recovery area — usually for at least one to two hours, or longer if sedation was heavy or a complex therapeutic procedure was performed.
• Eating and drinking: Your throat will still be partly numb after the procedure. Your team will advise when it is safe to swallow again — usually once you can feel your throat normally. Start with small sips of water before eating solid food.
• Driving and operating machinery: Because of the sedative, you must not drive or operate heavy machinery for the rest of that day. Arrange for someone to take you home.
• Voice and throat: A hoarse voice and mild sore throat are normal and usually ease within one to two days. Avoid speaking loudly or for long periods immediately after the procedure.
• Activity: Light rest for the remainder of the day is typical. Most people return to normal daily activities within a day, unless a more involved procedure was carried out.
• Coughing up small amounts of blood-tinged mucus: This is common, especially if a biopsy was taken, and usually settles quickly. Bright red blood, large amounts of blood, or worsening breathlessness should be reported to your doctor immediately.
• Chest X-ray: A follow-up chest X-ray is often taken shortly after the procedure to check that the lungs have remained fully inflated.
• Biopsy or laboratory results: If samples were collected, results typically take several days to a week or more depending on the type of analysis needed. Your doctor will arrange a follow-up appointment to discuss findings and next steps.
• Medicines: Your doctor will advise when to restart any medicines that were paused before the procedure.
• When to seek urgent help: Seek immediate medical attention if you experience severe shortness of breath, chest pain, a high fever, or are coughing up significant amounts of blood after going home.