Bronchoscopy

bronchoscope

A bronchoscopy is an examination of the tubes in the lung.

Dr Allen uses a soft, thin bendable tube (bronchoscope) to look at the voice box and bronchial tubes in the lung. This is to find the cause of lung problems you may have. Small samples of tissue and cells may be removed and sent for tests.

How is the bronchoscopy done?

You must not eat or drink anything for at least 6 hours before the procedure. You should discuss the taking of your usual medications with your doctor. Remember to bring your X-rays or CT scans with you as Dr Allen may need these.

Your nose and throat may be sprayed with a local anaesthetic to make them numb. You may be given a sedative drug by injection in a vein to make you feel more comfortable. Sometimes you will not remember having the bronchoscopy because of the sedative. The bronchoscope will be passed through the mouth or nose down through the voice box into the air tubes in the lungs. More local anaesthetic is used to numb the air tubes. The bronchoscope does not stop your normal breathing. You may cough but this normally settles once the local anaesthetic takes effect. The procedure usually takes between 10 and 30 minutes.

If samples are taken, they are sent to Pathology for tests. It may take a few days before we get a result. These are some of the samples that can be taken:

  • Endo-bronchial biopsy: Small samples are taken from the inside lining of the bronchi.
  • Bronchial brushings: The doctor passes a small brush on the inside lining of the bronchi.
  • Bronchial washings: A small amount of saline solution is put into the air tubes and sucked back through the bronchoscope into a specimen jar.
  • Broncho-alveolar lavage: Saline solution (about 100 ml) is put into a single small air tube and sucked back into a specimen jar. This collects cells from the air sacs (alveoli) of the lung.
  • Trans-bronchial needle aspiration: a needle is passed through the wall of the bronchi to take samples from the outside the wall.

Risks of this Procedure

Bronchoscopy is simple and very safe. It is unlikely to cause problems unless you have serious heart or lung problems. Major or life-threatening complications are very unlikely- about 1 in 300 patients having a bronchoscopy. It always depends on how sick the patient is in the beginning. They include:

  • Low oxygen levels (Hypoxemia). During the test your oxygen levels are measured and you may be given oxygen.
  • A rare risk, a collapsed lung (Pneumothorax) is a small hole in the surface of the lung that can happen after a trans – bronchial lung biopsy in less than 1% of procedures. Air then leaks from the lung, causing the lung to collapse. The lung may come back up itself, but for 1 in 2 people who get a collapsed lung a tube has to be put through the skin into the chest. This removes the air from around the lung and may need a longer hospital stay.
  • Heart problems. Bronchoscopy can cause abnormal cardiac rhythms such as atrial fibrillation.
  • Bleeding. This can happen after biopsies. Normally it is only minor and settles quickly. If the bronchoscopy is passed through the nose then bleeding from the nose may occur. Severe bleeding is rare and is more common in transbronchial biopsies. Bleeding is more common if you have been taking Warfarin, fish oil supplements, aspirin or drugs for arthritis or back pain. Ask your doctor if and when you should stop taking such drugs.
  • Reactions to sedation or local anaesthetic. This can include vomiting and rare allergic reactions.
  • Narrowing of vocal cords (laryngospasm). This is usually short lived and rarely a problem.
  • Asthma-like reactions. The bronchi can be narrowed due to irritation by the procedure. This is usually prevented by premedication with nebulised a bronchodilator such as Ventolin.
  • Fever. This may happen after bronchoalveolar lavage and is treated with paracetamol (Panadol).
  • Rarely, you may get an infection.
  • Death is extremely rare – about 1 in 2,500 patients.

What happens afterwards?

You will need to recover from the procedure in the hospital for 2-4 hours, and may have a chest x-ray to make sure your lung has not collapsed if you have had a trans-bronchial lung biopsy or bronchial brushing’s.

You must be taken home by a responsible adult.

You must not drive a car or motorcycle (this is against the law), operate machinery or drink alcohol for 24 hours after the procedure.

We recommend that you do not fly in an airplane for 24 hours after the procedure.

You should not make any important decisions or sign any contracts within 24 hours after the procedure.

If you are elderly or frail you may need a responsible adult to care for you that day/night.

In the 12 hours following the test you may:

  • Cough up small amounts of blood
  • Have a fever
  • Feel sick
  • Have a sore throat and hoarse voice.

Contact Dr Allen or the hospital if you have:

  • A fever that does not go away
  • Vomiting
  • More than a tablespoon (20ml) of blood when you cough

Contact Dr Allen or hospital IMMEDIATELY IF YOU HAVE:

  • Shortness of breath
  • Chest pain
  • If you coughed up more than 150mls of blood
  • Passed out or fainted.