A Diagnostic Examination of the Lungs
A bronchoscopy is an examination of the air passages leading to your lungs. It involves passing a narrow, flexible instrument through the mouth or nose and into the airways. The procedure itself, which is useful in the diagnosis and treatment of pulmonary disorders, involves little risk and is not painful.
Why have a bronchoscopic exam?
With the aid of a bronchoscope, a visual examination of the air passages can be made. In some cases, this visual exam allows immediate diagnosis. In others, particularly those in which abnormal growths, secretions, or blood are present, a sample might be taken through the bronchoscope for lab testing to aid in the diagnosis.
What are brushings, washings, biopsies?
During a brushing, a soft, sterile brush resembling a pipe cleaner is inserted through a tube in the scope and used to gently wipe lung tissue or a lesion. When the brush is withdrawn, cells adhere to it and are taken to the laboratory for study. An X-ray might be used to ensure that the sample is taken from the exact site of the problem.
Washings and alveolar lavage are similar techniques. A small amount of salt solution is introduced into the lung then suctioned out. Cells that have floated back out with the solution are analyzed.
When a biopsy is needed, a device is passed through the bronchoscope, and a small sample of lung tissue is removed for microscopic examination. There is relatively little discomfort. However, you might briefly feel a sensation of tugging or pinching, but this will pass quickly.
Are there risks involved?
There is some risk to any medical procedure, but the frequency of complications with bronchoscopy is small and is clearly outweighed by the benefits of an accurate diagnosis. Pneumothorax (collapsed lung) and bleeding at the biopsy site are only remotely possible, and can be treated effectively and immediately if they do occur.
Preparing for the procedure: Patient instructions
If you have any medical problems, are taking any medicines or have allergies to any medicines, please tell the nurse at the time the examination is scheduled.
The examination requires that you have an empty stomach. You should not take in any food or fluids, or anything by mouth for eight hours before the test. If your bronchoscopy is scheduled in the morning (before noon), do not eat or drink after midnight. If you are taking medicines, you may take them with sips of water. You may take your medicines after your blood is drawn for lab work at 7:30 a.m.
If your bronchoscopy is scheduled for afternoon, you may have a light breakfast before 7 a.m., such as one piece of toast, juice and one cup of coffee. Take any medicine at that time. Do not eat or drink anything after 7:00 a.m.
You will be given medicine before the procedure as a relaxant. These medicines might make you somewhat groggy after the test. Therefore, an adult who can take you home must accompany you. You will not be allowed to drive.
To prepare for the procedure, the nurse will spray your throat to diminish your gag reflex. Your nose will also be numbed with this medicine. Also, the doctor will administer a small amount of oxygen into the windpipe and major air-passages of your lungs.
During the procedure
Although the procedure is painless, you might experience some discomfort for a short period of time. You will be able to breathe normally throughout the examination. There are some brief periods when you might experience some shortness of breath. The procedure itself takes about one hour.
After the procedure
You will spend at least one hour in recovery while the relaxant and numbing medicines wear off. You will be reunited with your family at this time. Your doctor will then discuss some of the initial results with you. The specimens are sent to the lab for testing. It takes 48 to 72 hours for the final results, so you might need to come back to see your doctor to discuss the results.
Your mouth and throat will remain numb from the anesthesia as after a dental procedure. You should not eat or drink anything during the time it takes for the anesthesia to wear off, until your gag reflex returns to normal. This precaution is necessary to keep food or liquids from accidentally entering the windpipe and lungs, rather than passing directly into the esophagus and stomach. In addition, you might experience some hoarseness from the positioning of the bronchoscope.
What if I have questions?
Some apprehension is normal and the bronchoscopy staff will try to make your test as comfortable as possible. Most patients find that the examination is much less unpleasant than they anticipated. If you have any questions concerning the preparation for the exam, call your healthcare provider.
- If you have diabetes, we generally recommend that you take ½ of your usual dose of medicine or check with your internist for instructions. If you are taking oral medicine, you may hold your medicine for diabetes.
- If you have high blood pressure, take your medicine with a sip of water.
- If you take heart medicine, take it with a sip of water.
- It you take anti-seizure medicine, take it with a sip of water.
- Bring all of your medicines with you on the day of your appointment.
Do not take aspirin, products containing aspirin, products containing ibuprofen, non-steroidal products, Plavix, pletal, Coumadin, or heparin for five days before the procedure. These medicines increase your risk of bleeding. Please contact your healthcare provider if you have concerns about stopping these medicines.