Bronchoscopy

Publication date Sep 21, 2007

This information tells you about a test to look inside your lungs. It explains how the test is done, how good it is, the risks involved and what to expect afterwards.

The information about the accuracy and risks of the test is based on research studies and may be different in your ho spital. You may want to talk about this with the doctors and nurses treating you.

What is a bronchoscopy?

A bronchoscopy is a test to look for disease inside your airways. These include your lungs, throat, voice box (larynx) and wi ndpipe (trachea).

During a bronchoscopy, a surgeon or doctor passes a tube through your nose or mouth and into your lungs to check for infections (such as tuberculosis and pneumonia), inflammation (red, swollen patches), bleeding or lung cancer.

If your doctor sees anything unusual during the test, he or she can take samples of tissue to look at more closely. This is called a biopsy.

The tube used in a bronchoscopy is called a bronchoscope. It can be flexible or rigid. Most people have a flexible bronchoscopy because it's safer and more comfortable. A rigid bronchoscope is a straight, hollow, metal tube that's sometimes used if you're having treatment. For example, if you have a small object, such as a peanut, stuck in your airways, a rigid bronchoscope can be used to remove it.

The information here is about flexible bronchoscopy.

Why do I need this test?

You might need a bronchoscopy if you have symptoms that could be caused by an infection or lung cancer. You may have a bronchoscopy if:[1]

You've been coughing up blood
You've had breathing problems for a long time and have other symptoms that can't be explained
You've been exposed to asbestos in the past, have chest pain, trouble breathing or unexplained symptoms, and a chest X-ray shows signs of cancer.

You may also have a bronchoscopy if you have one of the following symptoms that either can't be explained or has lasted more than three weeks:

Chest pain
Shoulder pain
Trouble breathing
Weight loss
A hoarse voice
A cough
Swollen fingers
Swelling in the glands in your neck or above the collar bone.

Most people who have a bronchoscopy have already had other tests to examine their chest. Guidelines from the National Institute for Health and Clinical Excellence (NICE), the government organisation that advises doctors about treatments, say that you should have a chest X-ray and a CT scan before a bronchoscopy.[2]

If these other tests show a shadow, blockage or lump in your lungs, a bronchoscopy helps your doctor check whether this is cancer.[2] A CT scan can also look for signs that cancer has spread beyond your chest.

To read more, see our information on lung cancer.

Some people have had a test where they cough up phlegm, which is then checked for signs of infection under a microscope. If you have a lung infection doctors can collect some cells from your lungs during a bronchoscopy to try and find the cause. This helps them decide what treatment will help clear up the infection.

If you have asthma and medicines aren't helping your symptoms, your doctor may suggest you have a bronchoscopy to find out what is causing the symptoms.

What happens during a bronchoscopy?

You have a bronchoscopy in hospital, but you can usually go home the same day. The test is done in an operating theatre or a room called an endoscopy suit e. But it's not an operation and you won't have a scar or stitches afterwards.

Preparing for your bronchoscopy

You'll need to stop eating at least four hours before your test, although you will be able to drink water until two hours before.[3]

You may be given medicine to reduce the amount of saliva you produce. This will make your throat feel dry, but some doctors say it makes the test easier and quicker.[3] [4]

If you have asthma, you may be given medicine to open up your airways. This will help you breathe during the test.[3]

During the bronchoscopy

You may be given a drug called a sedative to relax you, especially if you feel anxious.[5] This is usually given by an injection in the back of your hand. You'll feel a bit sleepy after the sedative, but it's not a general anaesthetic so you'll still be aware of what's going on around you.

You'll be given some local anaesthetic to numb the back of your nose and throat. This may be sprayed into the back of your throat, or you might be given a lozenge to suck or a mask to breathe through. The anaesthetic may taste unpleasant, but it should stop you gagging during the test.

This is what happens during the test.

You'll lie flat on your back with a pillow under your head, or sit or lean back in a chair.
Your doctor puts a long, bendy tube (the bronchoscope) through your nose, into your windpipe and down to your lungs. If the passages in your nose are too narrow for the tube, the test may be done through your mouth instead.
The tube has a light and camera on the end. The camera sends pictures of your airways back up the bronchoscope to a screen. The doctor watches the screen or looks through an eyepiece at the top of the bronchoscope while gently feeding it into your lungs.
As the tube goes deeper into your lungs, you may be given some more anaesthetic through a hollow channel by the side of the tube.
Your doctor checks your lungs for sore patches, damage, inflammation and lumps. The doctor will look at both sides of your lungs, and go down the airways as far as possible until they become too narrow.
Injecting some fluid into your lungs may help your doctor see cancer cells. This is called fluoroscopy. It helps doctors see the narrow parts of your lungs that the bronchoscope can't get down. A very thin bronchoscope may also be threaded down the thicker one to reach these smaller airways.
The doctor may also take some cells or samples of tissue from your airways to look at later. This can be done by washing or brushing an area to make the cells loose, and then sucking them through the hollow channel at the side of the bronchoscope. Or the doctor may cut away tiny bits of tissue with an instrument passed down the channel.

Having a bronchoscopy can be uncomfortable. You may feel the tube moving around inside your chest, and you may gag and cough. Taking deep, regular breaths can stop you coughing, but if it doesn't help you may be given some medicine.[6]

It's important that you don't try to talk during the test as this can damage your vocal cords. The nurse will tell you how to signal if you are in pain.

You should be able to breathe normally during a bronchoscopy. The doctor will check that you're getting enough oxygen by attaching a small device to one of your fingers. This measures the oxygen in your blood. If it falls too low, you'll be given extra oxygen to breathe. This goes through a soft tube in the nostril that isn't being used for the bronchoscope.

After the test, you may be given extra oxygen for a while, and nurses will monitor you.

If you have a condition called chronic obstructive pulmonary disease (also known as COPD or emphysema), you probably won't be given a sedative or extra oxygen because they can cause heart problems.[3]

Will it work?

Bronchoscopy is a good test for lung cancer and infections in the lungs. But some lung problems can be missed, usually because the damage is very deep inside the lungs and the bronchoscope was too big to get inside the small airways, or because not enough tissue was taken for testing.

Here's what the research shows about how well bronchoscopy works for diagnosing lung cancer.

About half the people who have a bronchoscopy because an X-ray has shown a lump or blockage in their lungs do have lung cancer.[7] [8]
A bronchoscopy will find cancer in 9 in 10 people who have cancer in the main part of their lungs. Your doctor will need to take several biopsies to get these results.[9]
But the test can be wrong. A bronchoscopy misses cancer in 1 in 10 people who have cancer in the main part of their lungs.
It's unlikely that you will be told you have cancer when you don't.
A bronchoscopy isn't as good at finding small tumours around the edges of your lungs. The tube can't reach there. A bronchoscopy will find cancers in about 6 in 10 people who have tumours around the edge of their lungs that are more than 2 centimetres (about an inch) across. But a bronchoscopy will only find cancers in about 3 in 10 people who have smaller tumours.[9]

You are more likely to get an accurate result if your doctor cuts away bits of lung tissue to look at under a microscope, rather than washing or brushing out cells.[9]

If an X-ray shows that you have a lump or suspicious area on your lungs, but the bronchoscopy doesn't find cancer, then you'll probably need more tests to find out what it is.[9]

What are the risks of a bronchoscopy?

Very few people have problems during or after their test. You may lose your voice and have a sore throat, but these will quickly get better. To soothe your throat, try gargling with salt water or sucking lozenges.

You may also feel sick or vomit. And your blood pressure may drop. These problems may be caused by the sedative or anaesthetic you had during the bronchoscopy.

Serious problems after a bronchoscopy are rare, and are usually easy to treat. You're more likely to get one of these if you have a heart condition or liver problem, or a weakened immune system (if you've been treated for cancer, for example).[3]

High temperature

You might get a temperature, especially if you've had some cells taken from your lungs by washing some lung tissue. This happens to about a quarter of people who have a bronchoscopy.[10] But it's not usually serious.[11] [12] Very few people with a high temperature have a serious infection (pneumonia, for example) that needs to be treated with antibiotics.[10]

Irregular heartbeat

An irregular heartbeat can happen because you don't have enough oxygen in your blood.[10] You may be more at risk of having too little oxygen in your blood if you are over 80 years old or if you have a lung problem called pulmonary fibrosis.[13] But your oxygen level will be monitored and you'll be given extra oxygen if you need it, so this problem is rare.

Ble eding: you might get bleeding in your lungs if your lung tears when the doctor takes a sample of tissue. About 1 or 2 out of 100 people have bleeding.[14] [15] But it's not usually serious, and can normally be stopped fairly easily.

Trapped air: air can get trapped in the space between your lungs and your chest wall. This is called pneumothorax, and is more likely to happen if you have some tissue samples taken from your lungs. About 1 in 25 people get pneumothorax after a bronchoscopy with a biopsy.[14] It is treated by putting a needle or tube into your chest to let the air out. There is a small chance of pneumothorax happening after you leave hospital. If you have continuous, sharp chest pain and difficulty breathing, you may need to return to hospital.

Death: there is a very small risk of dying during a bronchoscopy. About 1 in 1,000 people who have a bronchoscopy die during or soon after the test.[16] [17]

Are there any alternatives?

A test called transthoracic needle biopsy can be used instead of bronchoscopy, or after a bronchoscopy. It's useful if doctors weren't able to reach the part of your lung they wanted to look at.

During the test, doctors look at an X-ray of your chest and insert a needle into your lungs in the place where there's a problem. They collect some cells through the needle and send these to be checked for cancer or an infection. A more accurate way to collect the cells is to insert a tube with a light at the end through a small hole in your chest. The light helps doctors look around the lungs to find the trouble spot.

They can then collect some cells using a needle and send them to be analysed in the laboratory. This test finds lung cancer in more than 9 in 10 people who have lung cancer, but it's only available in specialist centres.[2] You may need a general anaesthetic.[18] This test may be better than bronchoscopy at finding cancer around the edges of your lungs.[2]

Another test doctors might do is an operation called open lung biopsy. This is when doctors open up your chest so they can see your lungs. It is a serious operation and you need a general anaesthetic.

If your doctor suspects you have a lung infection such as tuberculosis (TB), you may have a phlegm (sputum) test. You are asked to cough up phlegm several times. This is then looked at under a microscope. This test finds tuberculosis in about 8 in 10 or 9 in 10 people who have the infection.[19] [20] It finds lung cancer in about 6 in 10 people who have cancer.[9]

You may also be offered a phlegm test if there is some reason why you can't have a bronchoscopy, or if you don't want a bronchoscopy, but there are signs of possible cancer in the central part of your lung. The phlegm test isn't as reliable as bronchoscopy for diagnosing cancer. So doctors only suggest this test when a bronchoscopy isn't possible.[2]

What will happen afterwards?

You may have an X-ray an hour or so after your bronchoscopy to make sure air isn't trapped in the space between your lungs and your chest wall (pneumothorax). If you have trapped air, you may need treatment to drain the air.

You'll probably be able to go home about two hours after the test. You should wait until you feel comfortable and can swallow normally. If you smoke and you have had some tissue samples taken from your airways, you shouldn't smoke for a while afterwards. It's best to give up smoking altogether. And you should try not to cough or clear your throat. This will help the area heal more quickly.

The surgeon or doctor may tell you what they saw before you go home. But if they took any samples of tissue or cells, you'll probably have to go back to the hospital about 10 days later to get your results.

If you had a sedative, you might not remember much about the test, and you won't be able to drive for about 24 hours. Make sure someone is with you when you go home.

Get back in touch with the hospital if you have any of these symptoms:

A high temperature
Sharp chest pain
Difficulty breathing
Coughing up a lot of blood (it's common to cough up about a tablespoon of blood after a biopsy).

References

National Institute for Health and Clinical Excellence. Referral guidelines for suspected cancer. June 2005. Clinical guideline 27. Available at http://www.nice.org.uk/cg027 (accessed on 25 August 2007).
National Institute for Health and Clinical Excellence. Lung cancer: diagnosis and treatment. February 2005. NICE clinical guideline 24. Available at http://www.nice.org.uk/cg024 (accessed on 3 July 2007).
British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001; 56 (supplement 1): 1-21.
Cowl CT, Prakash UB, Kruger BR. The role of anticholinergics in bronchoscopy: a randomized clinical trial. Chest. 2000; 118: 188-192.
Matot I, Kramer MR. Sedation in outpatient bronchoscopy. Respiratory Medicine. 2000; 94: 1145-1153.
Hewer RD, Jones PM, Thomas PS, et al. A prospective study of atropine premedication in flexible bronchoscopy. Australian and New Zealand Journal of Medicine. 2000; 30:466-469.
Libby DM, Henschke CI, Yankelevitz DF. The solitary pulmonary nodule: update 1995. American Journal of Medicine. 1995; 99: 491-496.
Lovich SF, Ostrow LB, Samples TL, et al. The solitary pulmonary nodule: a recent military experience. Military Medicine. 1990; 155: 266-268.
Rivera MP, Detterbeck F, Mehta AC. Diagnosis of lung cancer: the guidelines. Chest. 2003; 123(s1):129-136.
Stubbs S, Brutinel WM, Prakash U (editors). Complications of bronchoscopy. In: Bronchoscopy: a text atlas. Raven Press, New York, U.S.A.; 1994.
Yigla M, Oren I, Bentur L, et al. Incidence of bacteraemia following fibreoptic bronchoscopy. European Respiratory Journal. 1999; 14: 789-791.
Gillis S, Dann EJ, Berkman N, et al. Fatal Haemophilus influenzae septicemia following bronchoscopy in a splenectomized patient. Chest. 1993; 104: 1607-1069.
Shinagawa, N, Yamakazi K, Kinoshita I, et al. Susceptibility to oxygen desaturation during bronchoscopy in elderly patients with pulmonary fibrosis. Respiration. 2006; 73: 90-94.
Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest. 1995; 107: 430-432.
Cordasco EM Jr, Mehta AC, Ahmad M. Bronchoscopically induced bleeding: a summary of nine years' Cleveland clinic experience and review of the literature. Chest. 1991; 100: 1141-1147.
Sheldon RL. Flexible fibreoptic bronchoscopy. Primary Care. 1985; 12: 299-315.
Fulkerson WJ. Fibreoptic bronchoscopy. New England Journal of Medicine. 1984; 311: 511-515.
Black ER, Bordley DR, Tape TG, et al. Solitary pulmonary nodule. In: Diagnostic strategies for common medical problems. 2nd edition. American College of Physicians, Philadelphia, U.S.A.; 1999.
Anderson C, Inhaber N, Menzies D. Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis. American Journal of Respiratory and Critical Care Medicine. 1995;152(5):1570-1574.
Wong CF, Yew WW, Chan CY, et al. Rapid diagnosis of smear-negative pulmonary tuberculosis via fibreoptic bronchoscopy: utility of polymerase chain reaction in bronchial aspirates as an adjunct to transbronchial biopsies. Respiratory Medicine. 1998; 92: 815-819.

Glossary

tuberculosis: Tuberculosis (also known as TB) is an infection caused by certain . The most common type of tuberculosis is in the lungs. This can give pain in the chest, tiredness and a severe cough.
pneumonia: Pneumonia is an infection of the tissue in the lungs. Anything that causes infections (, or , for example) can give you pneumonia.
inflammation: Inflammation is when your skin or some other part of your body becomes red, swollen, hot and sore. Inflammation happens because your body is trying to protect you from germs, from something that's in your body and could harm you (like a splinter) or from things that cause allergies (these things are called allergens). Inflammation is one of the ways in which your body heals an infection or an injury.
X-ray: X-rays are pictures taken of the inside of the body. They are made by passing small amounts of radiation through the body and onto film. Larger amounts of radiation are used to treat some kinds of cancer.
CT scan: A CT scan is a type of X-ray. It takes several detailed pictures of the inside of your body from different angles. CT stands for computed tomography. It is also called a CAT scan (computed axial tomography).
asthma: Asthma is a disease of the lungs. It makes you wheeze, cough and feel short of breath. Asthma attacks are caused by and narrowing of the airways, which makes it hard for air to pass in and out of the lungs.
general anaesthetic: You may have a type of medicine called a general anaesthetic when you have surgery. It is given to make you unconscious so you don't feel pain when you have surgery.
local anaesthetic: Local anaesthetic is a painkiller for one area of the body. You usually get it as an injection. It makes that area numb. An example is the lidocaine you may get when your dentist fills a cavity.
low blood pressure: If your blood pressure is about 100/60 or less, your doctor may say that you have low blood pressure. Low blood pressure is usually not a problem unless it becomes too low to push blood to your brain and the rest of the body. If you have low blood pressure, you may sometimes feel dizzy when you stand up. To find out what these numbers mean, see .

This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.

Bronchoscopy

What is a bronchoscopy?

Why do I need this test?