The BTS Guideline on Diagnostic Flexible Bronchoscopy was published in August 2013 and includes a patient information leaflet which can be found here.
Why am I having the test?
Your doctor will explain the reason for the bronchoscopy. Ask again if you have not understood. Bronchoscopy is a very useful and commonly used test in lung disease. It can help to diagnose or exclude tumours, and help in the diagnosis of TB or other infections. It can be used to retrieve a foreign body e.g. a peanut which has been inhaled. It is sometimes helpful in patients who have a chronic cough which has not been explained by simpler tests. It is also used in some types of research e.g. bronchoscopy has contributed considerably into improving our knowledge and treatment of asthma.
What does it involve?
Most bronchoscopy is done under sedation and local anaesthetic with a flexible fibreoptic bronchoscope. Some bronchoscopy, for example in children and for removing an inhaled foreign body, is done under general anaesthesia with a rigid bronchoscope. In either case the instrument is manoeuvred around the main bronchi (central air passages) to inspect them and take samples. The bronchoscope can only see the central air passages because the bronchi are like the branches of a tree, getting smaller and smaller towards the edge of the lung, and rapidly become too narrow for it to pass further.
In patients having rigid bronchoscopy the anaesthetic is very similar to that for a minor operation (e.g. like a hernia repair). On waking up afterwards the throat may feel sore for a day or so.
In patients having fibreoptic bronchoscopy, local anaesthetic sprays are put into the back of the throat and local anaesthetic jelly or sprays are put in the nose. These taste a bit unpleasant. As the nose and throat become anaesthetised some patients feel as though they can not swallow properly. However, they can still swallow and this feeling wears off quickly after the test. An instrument called a pulse oximeter will be put on a finger. This does not hurt at all. It checks if you need to have oxygen during the test. If you are given oxygen to breathe, this is usually with a tube in the other side of the nose from the bronchoscope. Some sedation is then given through a needle in a vein in the back of the hand or arm. Some patients go of to sleep more or less completely with this, others simply find that they feel comfortable and relaxed. The sedation frequently causes some amnesia so many patients don't remember anything about the test afterwards.
Will it hurt?
There is no sensation of pain from bronchoscopy. It may be slightly uncomfortable as the bronchoscope tube first goes through the nose but this will settle down. For patients who have narrow nasal passages the tube can be put through the mouth instead, using a mouth guard so that the patient does not accidentally bite the bronchoscope and damage it. The bronchoscope does tend to make patients cough. Concentrating on taking regular deep breaths helps to reduce coughing and speeds up the test.
How should I prepare for the test?
You should have nothing to eat or drink for at least 4 hours before the test (some doctors may recommend a different period of fasting). Make sure that a friend or relative is available to drive you home afterwards. You should not drive a motor vehicle for 24 hours after the test to be sure that the effects of the sedation have completely worn off and do not affect driving safety. Remove false teeth before the procedure. If you have any lose teeth or major dental work (bridges, crowns etc. make sure your doctor knows about this (particularly if you are having a rigid bronchoscopy under general anaesthetic).
What happens after the test?
You will be kept in a recovery area for an hour or two after the test. You may be given oxygen. You may cough up some blood if you have had biopsies and you should not worry about this unless you are repeatedly coughing up large amounts of blood in which case report back to your doctor. It may be possible to give you some information immediately after the test but often this has to wait until a follow up appointment to allow time for the samples to be processed and examined by the pathologist. Because of the amnesia that some patients get from the sedation many patients can't remember what they have been told when they first recover from the test anyway.
Is it safe?
Bronchoscopy is a very safe test. The risk of serious complications is less than 1 in 1000 bronchoscopies.