Respiratory - Flexible Bronchoscopy

What is a bronchoscopy?

Flexible bronchoscopy is an investigation which involves inspection of the breathing passages using a fine plastic telescope called a flexible bronchoscope. Your doctor has recommended a bronchoscopy. However, the decision is yours as to whether to have the procedure or not. This leaflet will give you enough information about the risks and benefits so that you can make an informed decision.

The doctor will describe the procedure to you and the reasons for requesting the test in your case. If you require any more information about this test, please ask your doctor or any member of the health care team about the test or see details at the end of this leaflet. You will be asked to sign a consent form once you have read this leaflet and your questions have been answered.

Why do I need a bronchoscopy?

Your doctor may have recommended the procedure to look for an abnormality in your airways or to take samples of lung tissue or lung fluids through the bronchoscope.

Are there any alternatives to a bronchoscopy?

Other tests such as x-rays may give some information about the lungs but only a bronchoscope can allow the doctor to see inside the breathing passages and to take samples.

The procedure can be done by a surgeon under general anaesthetic (this is called Rigid Bronchoscopy) but this is a more major procedure. In some cases, a lung biopsy can be taken from outside the chest under local anaesthetic.

What will happen if I decide not to have a bronchoscopy?

Without a bronchoscopy, your doctor may not be able to find out what is wrong with you and it may not be possible to give the correct treatment. If you decide not to have a bronchoscopy, you should discuss this carefully with your doctor.

Will I need sedation for the test?

You will be offered the opportunity to have sedation before the procedure but you may also have the procedure without sedation if you prefer.

Our experience is that most patients report only mild or very mild discomfort from this test and about a quarter of patients decide to have the test without sedation.
 
However, people who feel anxious about the test tolerate it better with light sedation. This is not a general anaesthetic but you might not remember having the test.

What does the procedure involve?

If you request sedation, the operator will give this through a small needle in the back of your hand or arm vein. They will put anaesthetic jelly in your nose to make it numb and they may also spray some local anaesthetic on your throat.

The operator will pass a narrow (6mm; less than ¼ inch) plastic telescope through your nose (or sometimes through the mouth) and spray local anaesthetic on your throat and voice box through a hollow channel in the bronchoscope.

When the throat is numb, the operator will pass the bronchoscope into the breathing passages and inspect these passages (this can cause a tickling sensation and you may cough - this is not a problem for the operator).

The operator will spray some more local anaesthetic into the airways and may take some samples such a small tissue specimen (biopsy) or fine-needle aspirate specimen or some fluid washings from the airways. The test can take from 5 to 30 minutes depending on how many specimens (if any) are required.

What about oxygen and other drugs (including diabetes medicines)?

If you have diabetes, please discuss your diabetes medicines with hospital staff or Diabetes Nurses. If you are on Warfarin, or other medication to thin the blood, you will need to stop it before the test - discuss the details with your doctor.
 
Take all other medicines (tablets, inhalers etc) at the usual times on the day of the test. Breathless patients may be given oxygen during the test using a soft oxygen tube in the nostrils.

Do I need to avoid eating and drinking before the test?

You must have no food for at least 4 hours and no drinks for at least 3 hours before the test. If you have diabetes, please discuss your diabetes control with hospital staff or Diabetes Nurses.

Is the procedure painful?

The procedure causes some discomfort in the nose and it may make you cough but there is plenty of room to breathe around the bronchoscope.

You will have local anaesthetic jelly applied inside your nose and local anaesthetic will be sprayed on your throat. The anaesthetic has a bitter taste but it does not cause any pain.

What are the possible side-effects and complications?

Bronchoscopy is a very safe procedure for most patients. Some patients feel feverish a few hours after bronchoscopy. This is not dangerous and can be treated with paracetamol. The operator may take a very small piece of tissue (a biopsy) from the wall of the airway using a forceps.

Tissue may also be sampled using a small brush or a very fine- needle. These procedures are painless. It is common to cough up a few spots of blood after this procedure but serious bleeding is very uncommon.

Some people have a husky voice or sore throat for a few days after the test.

Rare complications

Include wheeziness or breathlessness or depression of respiration (especially if you already have severe breathing problems or if heavy sedation is requested).

All patients have cardiac and blood oxygen monitoring during the test as there is a slight risk of rapid or slow heart rhythms or feeling faint due to low blood pressure during the test. Please let us know if you have any history of heart problems.

All of these complications are uncommon and most can be dealt with easily and quickly by the medical team. The risk of death is about 1 per 5,000 tests, about the same risk as if you were to drive 44,000 miles in a car.

This risk is much lower for most patients and higher for people with very serious lung disease or heart disease. Please let us know if you have any specific concerns.

If you have a Transbronchial biopsy (small sample of lung tissue), there is about 1-2% risk of pneumothorax (like a small puncture of the lung).

This often requires no intervention. However, if required this can be dealt with easily be placing a small drain between the ribs after numbing the area with local anaesthetic. If you should need this test (most patients do not), you would be warned in advance of this risk and given a special information leaflet advising you about this risk.

How soon will I recover?

Most people are alert or lightly sedated at the end of the test. If you are sleepy, you will be allowed to rest in the Endoscopy Unit (if you are an outpatient) or on your own ward if you are an inpatient.

The nurses will offer you a drink of water once you are fully awake and once the local anaesthetic spray on your throat has worn off (at least an hour after the test). If you can swallow the water safely, you will be allowed any other food and drink that you wish to have.

If you wish to be sedated, please arrange for someone else to accompany you as you go home (they will also need to stay in the same building as you overnight) and avoid alcohol for the rest of the day. Do not go to work or drive or operate machinery or sign any important documents if you have been sedated. The sedation will have worn off fully by the following day.

When will I get the results of the test?

After the test, the operator may be able to tell you if any abnormality was seen but results of biopsies and other tests can take several days. These will be discussed with you at the clinic or over the telephone if you are an outpatient or on the ward if you are an inpatient.

Further Information:

If you require further information please telephone: 0161 206 4039

You can get further information from:

NHS 111 Service
When less urgent than 999
111

NHS
www.nhs.uk

British Thoracic Society
http://www.brit-thoracic.org.uk

British Lung Foundation
03000 030 555
or on their website: www.blf.org.uk/Home

Use of bronchoscopy record for audit, education and research

We use the computerised bronchoscopy database for audit and research but we do not use any personal details such as people’s names in this research. Please let us know if you would not wish us to use your computerised bronchoscopy record for research purposes