Bronchoscopy

What is bronchoscopy?

A bronchoscopy is a diagnostic examination that allows the doctor to take a look at the airways and the lungs. Bronchoscopy can be therapeutic in a bid to relieve certain symptoms – for instance clearing an airway that is blocked.

This procedure takes a very short time during which a thin flexible tube, about 2 feet in length and a centimeter in width, called a bronchoscope inserted either through the mouth or the nose into the lungs. A bronchoscope is an instrument that has a light and camera attached to it. This scope helps health care providers view the interiors of airways and lungs.

The bronchoscope can be either rigid or flexible. A flexible bronchoscope is more often used than a rigid one. The doctor is able to examine the lungs and detect the presence of tumors, infection or other diseases in the lungs. Patients do not experience pain during this procedure, only slight discomfort. If required, during bronchoscopy, stents may be introduced in the airways or a tissue sample collected for biopsy.

Bronchoscopy is a very safe procedure and the risk of death with either flexible or rigid bronchoscopy procedures is below 0.1 percent.

When is bronchoscopy recommended?

Breathing difficulties cause doctors to investigate further using bronchoscopy. This diagnostic procedure is also used to investigate following an abnormal scan report. A bronchoscopy can diagnose the following medical conditions:

– Lung problems
– Lung infection
– Bleeding
– Tumor in the lungs
– Persistent cough
– Collapsed lung
– Spot signs of lung rejection after transplant

Bronchoscopy can also be used to offer treatment in the following manner:

– Cancer treatment
– Inhalation of toxic gas or chemicals
– Draining out mucus from the airways
– Removing objects lodged in the airway
– Widen a constricted airway
– Draining an abscess
– Coughing blood, medically called hemoptysis

How many deaths are caused by lung diseases in India?

Lung diseases such as COPD are the second-most common cause of death in India. In 2017, almost a million people succumbed to this disease, which was close to 13% of all fatalities recorded that year. Studies also reveal that more than 7.5 million people in India fall into the high-risk category of acquiring COPD.

How do I prepare for bronchoscopy?

– Firstly, follow the doctor’s advice completely.

– Keep your doctor informed regarding your current medications- more specifically medicines such as blood thinners. There is a chance that some of these medications are stopped before the procedure.

– You will need to be in the hospital for a few hours during which time your vital parameters are monitored. It also enables time for the effects of the medicines and sedatives to wear off.

– The cough reflex is restored after about 2 hours of the procedure. Only after this should you eat and drink again.

– It is better to not attempt at driving or operating machinery for a day following the procedure. Alcohol for 24 hours following the procedure is a strict no-no.

How is bronchoscopy performed?

Bronchoscopy is performed by a pulmonologist. Bronchoscopy can be performed using two types of scopes – flexible and rigid. The type commonly used is the flexible bronchoscope. This can be performed under sedation or local anesthesia.

– The rigid bronchoscope employs a thicker metal tube and this necessarily means the patient has to be administered general anesthesia in an operating room in the hospital.

– Bronchoscopy is mostly performed in a hospital.  If a flexible bronchoscopy is used, it is performed in a special procedure room. Your specialist evaluates your medical condition and the objective of the test before deciding on the type of bronchoscope to use for the procedure.

– Local anesthesia is used at most times during bronchoscopy. Only in extremely rare cases is a general anesthetic used. If patients are tense, a sedative can be prescribed to relax. Your physician uses a local anesthetic inside the nose and throat.

– A flexible tube is slowly inserted into the nose and throat and enters the bronchi. Next, the tube is guided to the lungs.

– Patients experience slight discomfort akin to a feeling of wanting to cough but it reduces within no time.

– In most cases, breathing assistance in the form of oxygen is given to the patient. Doctors can get a good view of the airways and lungs.

– Doctors do convey instruments, needles, brushes or a stent inside a channel in the bronchoscope. It is also possible to perform a biopsy for further investigation.

– At times a procedure called lavage or bronchial washing is performed. During this procedure, a saline spray is used in the airways to make it easy to collect fluids and cells for further investigation.

– Sometimes experts may want to conduct a detailed study of the lymph nodes and tissues around the bronchi. In such cases, an ultrasound is performed.

– This procedure actually gets done in about 30 minutes or even earlier after which the bronchoscope is taken out.

– You are allowed to go back home on the same day. It is better if you have someone with you to drive you home especially after intake of sedatives.

Do I need to fast for bronchoscopy?

You should ideally keep your stomach empty for about 6 to 10 hours prior to the schedule of this examination.

What do the results mean?

A normal bronchoscopy result implies that there was nothing abnormal found during the procedure. This means there was no abnormal fluid or cells in the bronchi, or blockages or the presence of any foreign particles. A positive bronchoscopy result could mean any of the following diagnoses:

– Swelling of lung tissue
– Presence of parasites
– Presence of virus or bacteria causing infection
– Tumor
– Lung damage
– Bacterial infection
– Narrowed bronchi
– Refusal of the transplanted lung

What else should I know about bronchoscopy?

Bronchoscopy can form an integral part of the treatment for lung cancer especially when the tumor is in or close to the airways. In such cases, bronchoscopy and brachytherapy go together to help patients.  With brachytherapy, it is possible to directly deliver radiation to the tumor using a bronchoscope.
 
New technologies assist in the diagnosis of early lung cancer. Some of these technologies are narrowband imagery, video bronchoscopy with magnification, and autofluorescence bronchoscopy.

Is bronchoscopy a risky procedure?

You should be aware of some of the risks and complications of bronchoscopy, although it is normally a safe procedure. Some of the risks include:

– Fever
– Breathing problems
– Pneumonia
– Arrhythmia
– Infection
– Minimal bleeding post-biopsy
– Reduced blood oxygen levels
– Heart attack risk among those with heart conditions

In very rare cases, especially if a rigid bronchoscope is used during bronchoscopy, the lung can get punctured. This is a very serious condition called pneumothorax. Immediate medical treatment is needed.If bronchoscopy is performed under general anesthesia, then you may experience nausea, muscle pain, changes in blood pressure, vomiting, and a reduced heart rate.

Can bronchoscopy be performed during pregnancy?

Absolute usefulness and safety of bronchoscopy during pregnancy is yet to be proved. Research and studies are still inadequate in this area. Till we have conclusive evidence of the safety of bronchoscopy during pregnancy, it is better to avoid this procedure during this time.

What are the instances when bronchoscopy should not be performed?

A bronchoscopy is not advisable when patients are victims of the following:

– Recent heart attack
– Severe respiratory failure with hypercapnia
– Serious untreatable arrhythmia
– Inability to oxygenate the patient during the procedure
– Coagulopathy, which means a problem in blood clotting
– A blockage in the trachea
– Uncooperative patient

In certain cases, bronchoscopy cannot be performed for therapeutic purposes.  Those who cannot undergo therapeutic bronchoscopy are those that are suffering from:

– Pulmonary hypertension
– Block in the superior vena cava
– Advanced kidney disease

Can bronchoscopy be performed on infants below 6 months?

Flexible bronchoscopy is performed on infants using sedation to help babies feel a bit drowsy and relaxed through the procedure. Doctors will continuously monitor your child’s oxygen level, heart rate, blood pressure and temperature throughout the procedure. Children of all ages can undergo bronchoscopy.

What are some of the dos and don’ts of this procedure?