In a flexible bronchoscopy, your doctor will use a flexible tube with a camera at the end, called a bronchoscope, to see down your airways. They’ll pass it down your nose or mouth, and then to the back of your throat to reach your lungs.
Your doctor can take samples of cells from your airways and remove a small piece of tissue (biopsy) so that these can be examined in a lab.
You’ll meet the doctor who’s going to do your bronchoscopy to discuss your care. It might not be exactly the same as what we’ve described here, as it will be tailored to meet your individual needs.
Your doctor has the option of using a rigid bronchoscope during the procedure but this isn’t common. It’s normally only used if your doctor needs to use larger instruments and cameras to look at and treat any problems with your airways. You’ll need to have a general anaesthetic if you have a rigid bronchoscopy. Sometimes a flexible and rigid bronchoscope are used together.
Your doctor will have talked through everything in detail before you’re admitted to hospital, and given you the opportunity to ask questions. They’ll have described the risks, benefits and alternatives to the procedure and the differences between a flexible and a rigid bronchoscopy. You should then be in a position where you understand everything so can give your consent for it to go ahead.
Your doctor will talk to you about why you need to have a bronchoscopy. Here’s just some of the possible reasons why you might need to have one.
- Bleeding. If you’re coughing up blood, your doctor can use a bronchoscopy to look inside your airways to see where the blood is coming from.
- Follow up a chest X-ray. If your doctor sees something on an X-ray that they want to take a closer look at, they might use a bronchoscopy. They can take samples at the same time.
- A long-lasting cough. A bronchoscopy might help your doctor find the cause.
- An infection. If your lungs are infected, your doctor might need to take some samples of mucus to help find out what’s causing your infection and how best to treat it.
- Lung cancer staging. If you have lung cancer, a bronchoscopy can help to determine if it has spread, or to help deliver treatment.
You’ll usually have a flexible bronchoscopy as an outpatient and won’t need to stay overnight in hospital. This means you will have the bronchoscopy and go home the same day.
You shouldn’t eat anything four hours before your bronchoscopy, or drink anything two hours before it. Don’t smoke immediately before the procedure either.
Flexible bronchoscopy is normally done under local anaesthesia. This will numb your nose and throat but you’ll be awake during the procedure. It may feel slightly uncomfortable when the bronchoscope goes down your nose or mouth, but this shouldn't last long. Your doctor might also offer you a sedative, which will make you feel more relaxed.
It's natural to feel worried about having a bronchoscopy. Your doctor will explain what happens at each stage, including any discomfort you might have, so you know what to expect. If you’re unsure about anything, ask. No question is too small.
Being fully informed will help you feel more at ease and will allow you to give your consent for the bronchoscopy to go ahead. You may be asked to do this by signing a consent form. If you’re not sure you want to have the bronchoscopy, you can take more time to decide. Your doctor won’t carry out the procedure until you understand and agree with what’s going to happen.
Your doctor may ask you to have an X-ray or a computerised tomography (CT) scan to look at your lungs. But only a bronchoscopy lets your doctor take samples of tissue within your airways and look at them in more detail.
A bronchoscopy usually takes about half an hour to an hour.
Your nurse will check your heart rate and blood pressure before and throughout the procedure.
Your doctor will spray a local anaesthetic into your nose or throat, or spray it at the back of your throat to numb the area. They’ll then pass the bronchoscope through your nose or mouth to the back of your throat and numb your voice box (larynx) with more anaesthetic. It might make you cough, but try not to worry as this is common and it should soon settle down. Your doctor will choose a local anaesthetic that’s thought to help reduce this.
It’s best to breathe normally and to keep relaxed. If you find yourself getting anxious, concentrate on taking slow breaths to help yourself calm down. If you’re very anxious, your doctor may give you a sedative injection to help you relax before the procedure begins.
Your doctor will then have a look at your airways using the bronchoscope. Images from the camera will be projected onto a monitor. They might take some samples of tissue (biopsy) or mucus from any abnormal areas. After your doctor has examined your airways, they’ll remove the bronchoscope.
A nurse will keep an eye on you while you recover, and check your heart rate and blood pressure. You might need to have a chest X-ray to check for potential complications but this isn’t always necessary.
It’s normal to have a small amount of blood in your mouth after the procedure.
You’ll need to rest until the effects of the local anaesthetic and sedation have passed. It can take several hours after a local anaesthetic for the feeling to come back fully into your nose, mouth and throat. So take care, and don’t have any hot drinks or eat anything until the feeling comes back.
Having a sedative can take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.
Your doctor might be able to go through your results straightaway. If your doctor took samples during the bronchoscopy, they’ll tell you when the results will be ready, which is usually within a week. If you’ve had a sedative, it’s a good idea to have someone with you as it might be difficult to remember what they tell you.
You’ll usually be able to go home when you feel ready, usually after about an hour. Make sure someone can take you home. And ask a friend or relative to stay with you for a day or so while the sedative wears off.
It’s unlikely that you’ll have any problems after your bronchoscopy, but tell the nurse who’s monitoring you if you:
- have chest pain
- have difficulty breathing
- cough up blood
You probably won’t have any problems after you get home, other than some mild side-effects that are listed below. You should be able to get back to your usual activities, including work, the next day but follow your doctor’s advice.
If you do have any pain or discomfort, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
As with every procedure, there are some risks associated with a bronchoscopy. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. After a bronchoscopy, you may have a:
- sore throat
- hoarse voice
- a fever
You might also cough up a little blood. This isn’t usually much at all.
Complications are when problems occur during or after the procedure. Complications of bronchoscopy are rare but can include:
- severe bleeding
- problems with your heart rhythm
- a collapsed lung
- a seizure
- an infection
- wheezing or breathlessness
When you have bronchoscopy, your doctor will pass the bronchoscope down your nose or mouth, and then to the back of your throat. This might make your voice hoarse and give you a sore throat after the procedure, so it’s best to let your voice return to normal before you sing.
If you’re worried, ask your doctor before your procedure about whether you should rest your voice until any hoarseness goes away.
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- Bronchoscopy. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2013
- Jain K, Wainwright C, Smyth AR. Bronchoscopy-guided antimicrobial therapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2016, Issue 1. doi: 10.1002/14651858.CD009530.pub3
- Du Rand IA, Blaikley J, Booton R, et al. British Thoracic Society guideline for diagnostic ﬂexible bronchoscopy in adults. Thorax 2013; 68:i1–i44. doi:10.1136/thoraxjnl-2013-203618
- Bronchoscopy. British Thoracic Society. www.brit-thoracic.org.uk, accessed 24 October 2016 Fiberoptic bronchoscopy. American Thoracic Society. www.thoracic.org, accessed 25 October 2016
- Personal communication, Professor Howard Branley, Consultant in Respiratory Medicine, The Wellington Hospital, Hospital of St John and St Elizabeth, and Consultant Adviser in Respiratory Aviation Medicine to the UK Civil Aviation Authority (CAA), 8 December 2016
- American Thoracic Society. Fiberoptic bronchoscopy. Am J Respir Crit Care Med 2015; 191(7–8)
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2016
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Next review due December 2019
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