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Bronchoscopy


Expert reviewer, Dr Richard Russell, Respiratory Consultant
Next review due April 2022

Bronchoscopy is a procedure that allows a doctor to look at the airways inside your lungs. Your doctor can use it to see if there are any problems, collect samples, and sometimes treat the problem too.

A doctor is showing the patient some leaflets

Types of bronchoscopy

There are two types of bronchoscopy.

  • Flexible bronchoscopy. This is the most common type. It involves passing a flexible tube that projects light (called a bronchoscope), down your nose or mouth to see into your airways. The bronchoscope can bend and twist to get to the different parts of your airways.
  • Rigid bronchoscopy. This is used much less often. It uses a metal tube, which is passed into your mouth to reach your main airway. It’s normally only used for specific problems where your doctor needs to use larger instruments. You’ll need to have a general anaesthetic if you have a rigid bronchoscopy.

Flexible bronchoscopy is used for the vast majority of cases these days, as it’s a simpler procedure and you don’t need to have a general anaesthetic. But there are still times when a rigid bronchoscopy is a better option. Sometimes, a flexible and rigid bronchoscope are used together.

In both types, your doctor can fit a small video camera onto the end of the bronchoscope, so they can see inside your airways. Your doctor can take samples of cells from your airways during the bronchoscopy, and also remove a small piece of tissue (biopsy). These can then be examined in a lab.

In this topic, we discuss mainly flexible bronchoscopy.

Why do I need a bronchoscopy?

Your doctor will talk to you about why you need to have a bronchoscopy. Here are some of the 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. If necessary, the bronchoscope can be used to suck out any blood from your airways too.
  • Follow up after a chest X-ray. If an X-ray image shows something abnormal in your lungs, your doctor may want to take a closer look using a bronchoscope.
  • A persistent (long-lasting) cough. A bronchoscopy might help your doctor to find the cause.
  • To help diagnose a lung infection indicated by an X-ray or other test. A bronchoscopy to take some samples of mucus might help to find out what’s causing your infection and how best to treat it.
  • Lung cancer staging. If you have lung cancer, a bronchoscopy may help to determine if it has spread.
  • To investigate respiratory symptoms such as wheezing, changes to your voice (for example, hoarseness) or trouble with your breathing.
  • Looking for and removing objects that may have got stuck in your airways (usually in young children). This would usually be done with a rigid bronchoscopy.
  • Looking for other blockages in your airways and treating these (for example, with laser therapy or placing stents in your airways).

If your doctor has recommended that you have a bronchoscopy, they’ll discuss everything with you in detail. They’ll explain exactly what will happen during the procedure, what to expect afterwards and if there’s any risk of potential complications. If your doctor recommends that you have any treatment as part of your bronchoscopy, they’ll explain why and if there are any risks involved in this too.

You should be given time to make sure you understand everything and have an opportunity to ask any questions. If you’re happy to go ahead with the procedure, you’ll be asked to sign a consent form – so it’s important to make sure you feel properly informed.

Preparing for a flexible bronchoscopy

You’ll usually have a flexible bronchoscopy as an outpatient. This means you can go home the same day and usually won’t need to stay overnight in hospital. You’ll need to arrange for someone to drive you home and stay with you afterwards though, as it’s likely you’ll have a sedative. A sedative can make you feel drowsy for a while afterwards, so you won’t be able to drive yourself until the day after your bronchoscopy.

You’ll usually be advised not to eat anything for around four hours before your bronchoscopy or to drink anything for around two hours beforehand. It’s important to follow any advice given to you by the hospital on this. If you smoke, it’s best not to smoke before the procedure.

At the hospital, you may be asked to change into a hospital gown or you may be able to stay in your own clothes. A nurse will do some checks before your procedure, including checking your heart rate, oxygen levels, breathing rate and blood pressure. They’ll carry on monitoring these throughout the procedure. You’ll have a cannula (a drip) put into a vein in your arm or back of your hand, so that you can be given a sedative. You may be given oxygen to breathe too, either through a face mask or a plastic tube in your nose.

What happens during a flexible bronchoscopy procedure?

A bronchoscopy usually takes between 15 minutes and an hour. Your doctor will give you a more accurate estimate depending on what you’re having done.

If you’re having a sedative, you’ll be given this at the start of the bronchoscopy procedure. It’ll make you feel relaxed and a bit drowsy, but you should stay awake. You may be asked to sit or lie down for the procedure. Your doctor will spray a local anaesthetic into your nose or the back of your throat to numb the area. This might make you cough at first but try not to worry as this should soon settle down. If you’re having a bronchoscopy via your mouth, your doctor may also put a device in your mouth to stop you from biting down onto the bronchoscope.

Your doctor will then pass the bronchoscope up your nostril or into your mouth, to the back of your throat. This may feel a bit uncomfortable at first as the bronchoscopy goes down your nose or mouth, but it shouldn’t last for long. The camera on the bronchoscope will project images from inside your airways onto a monitor, for your doctor to view. After examining this area, your doctor may apply more anaesthetic, before passing the bronchoscope further down your windpipe and into your lungs.

Try to breathe normally and to keep relaxed. You’ll be carefully monitored throughout the procedure and offered more anaesthetic or sedation if you need it. It’s natural to feel worried about having a bronchoscopy procedure. If you find yourself getting anxious, concentrate on taking slow breaths to help yourself calm down.

There are a number of treatments your doctor may perform during the procedure, after they have viewed your airways. This might include injecting a saline solution through the bronchoscope to ‘wash out’ your airways or taking samples of tissue (biopsy) or mucus from any abnormal areas.

What to expect afterwards

A nurse will keep a close eye on you while you recover, and will continue checking your heart rate, breathing rate, oxygen levels and blood pressure. You might need to have a chest X-ray to check for potential complications, but this isn’t always necessary.

You won’t be able to eat or drink anything until the local anaesthetic wears off and feeling returns in the back of your throat. This normally takes an hour or two. It’s quite common to have a small amount of blood in your mouth after the procedure but tell your nurse if it starts to get worse. Also let your nurse know if you have any chest pain or trouble breathing.

Your doctor might be able to discuss some of the findings from your bronchoscopy while you’re still in hospital. But results of biopsies may take a week or so – your doctor will tell you when they should be ready.

Your nurse will tell you when you’re ok to go home. Make sure someone can take you home and can stay with you for a day or so while the sedative wears off. Having a sedative can really take it out of you. You might find that you're not so co-ordinated as usual or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, cook, operate machinery or sign anything important.

Recovering from a bronchoscopy

You may need to take things easy for a day or two after you get home. It’s common to have a sore throat for a couple of days after a bronchoscopy. You can take over-the-counter painkillers such as paracetamol or ibuprofen if you need to. You might have a hoarse voice or cough afterwards too. You should be able to get back to your usual activities, including going back to work, after 24 hours, but follow your doctor’s advice.

Complications of bronchoscopy

Complications are unexpected problems that can happen during or after the procedure. As with any procedure, there are some risks associated with having a bronchoscopy. Your doctor should explain these before you give your consent for the procedure. They will sometimes go over it again on the day itself.

Complications of bronchoscopy are rare but can include:

  • Bleeding during the procedure. Bleeding is usually a minor problem and stops on its own. But if it’s severe, you might need treatment to stop it.
  • Problems with your heart rhythm (arrhythmia).
  • A collapsed lung. This may happen if the bronchoscope tears your lung tissue, causing air to collect in the space around your lung. You’ll be monitored for signs of this after the procedure. It’s more common if you have a biopsy as part of your bronchoscopy.
  • Infection of your lung tissue. The instruments used during your procedure will all be sterilised to reduce this risk.


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Related information

    • Bronchoscopy. The MSD Manuals. www.msdmanuals.com, last full review/revision October 2016
    • Bronchoscopy. Encyclopaedia Britannica. www.britannica.com, accessed 18 March 2019
    • Cardiothoracic surgery. Oxford handbook of operative surgery. Oxford Medicine Online. oxfordmedicine.com, published May 2017
    • Du Rand IA, Blaikley J, Booton R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax 2013; 68:i1–i44
    • Consent: patients and doctors making decisions together. General Medical Council, June 2008. www.gmc-uk.org
    • Bronchoscopy patient information leaflet. British Thoracic Society. www.brit-thoracic.org.uk, accessed 19 March 2019
    • Bronchoscopy under local anaesthetic. Cancer Research UK. www.cancerresearchuk.org, last reviewed 24 July 2017
    • Sedation explained. Royal College of Anaesthetists, 2018. www.rcoa.ac.uk
    • Flexible bronchoscopy. American Thoracic Society, 2015. www.thoracic.org

  • Reviewed by Pippa Coulter, Freelance Health Editor, April 2019
    Expert reviewer, Dr Richard Russell, Respiratory Consultant
    Next review due April 2022



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