Bronchoscopy

Asthma Allergy & Pulmonary Associates, P.C.

1015 Chestnut Street

Philadelphia, PA 19107

In order to diagnose or treat your lung problem, our doctor may recommend a bronchoscopy. The following was written to answer common questions that patients have about this procedure. The doctor will explain to you why this may be the right test for you (benefit), as well as what the risks are and what other tests or treatment might be used instead to help you with your problem (alternatives). If you still have questions, please speak with one of our professional staff so that you understand.

What is a bronchoscope?

A bronchoscope is a special, flexible tube that can be used to evaluate the airways of the lung and to obtain samples for testing. Most bronchoscopes have a camera and a light at the end. The doctor can watch the view through the camera on a monitor and steer the bronchoscope to the central parts of the lung. Special instruments can be passed through a channel in the bronchoscope to reach parts of the lung beyond where the camera can see. The bronchoscope can be used to evaluate a potential bleeding site in the airway, examine many abnormalities, obtain secretions from a suspected pneumonia, or take pieces of lung tissue (biopsy) for later examination in the laboratory.

How is the test done?

The procedure is usually performed while the patient is awake but often with “conscious sedation”. This usually involves several different kinds of medications: one to help numb the nose and airway, another to help control cough and others to help keep the patient relaxed. While some people fall asleep with the medications, this is not the same as general anesthesia in the operating room. Most patients are comfortable and are able to go home in the same day.

Following the administration of the medications, the bronchoscope is passed through the nasal passage and into the airway. The airways are visualized and any necessary samples are obtained. The instrument is then taken out.

Outpatients are observed in the short procedure unit for several hours after the test is done. A chest x-ray is commonly obtained after the procedure to check for any problems that could occur. Once you are alert and are able to eat and drink, you can go home.

What preparation is needed?

Once you have decided to undergo bronchoscopy, you need to have some blood tests done. This is to check that you don’t have a bleeding disorder or other problem that might increase your risk. If appropriate, you may also need to see other doctors to be sure you are well enough for the procedure.

The night before the procedure, you need to stop eating or drinking after midnight.

You also need to avoid any medication that may prolong bleeding. These include aspirin, aspirin like products such as ibuprofen (Advil, Motrin) or naproxen. They also include medication such as Coumadin.

You should ask a friend or family member to drive you to and from the procedure. Although most people are alert at the time of discharge, the medications used during the procedure may slow your reaction time, making driving hazardous.

Are there any complications?

As with any medical procedures, even under the best of circumstances, problems may occur. Some of these problems may be more serious than others.

Generally less serious and more common problems include:

· some sleepiness for the remainder of the day

· a low grade fever

· some blood streaked sputum (less than one teaspoon)

The symptoms should resolve on their own by the next morning. If you have persistent or high fever or more than a little bleeding you should call our office and speak to the doctor. If your problem appears serious, it is best to go to the emergency room so that you are in a safe place and have the physician there call after you have been evaluated.

More serious problems may include, but are not limited to:

· reaction to medication

· infection

· bleeding from the nose or lungs

· nicking of the lung including pneumothorax

· injury to the voice box

In general, these complications occur in 2-5% of all the cases, or one in twenty to fifty cases. Rarely such problems can be life threatening, and very rarely (perhaps one in every 2000 patients) fatalities have been reported. Those usually occur in sicker patients, associated with a biopsy. Unfortunately, no doctor can guarantee absolutely the safety of this or any procedure.

Bronchoscopy can be extremely useful. It can often detect serious diseases such as lung cancer at a time that treatment can be curative. It may avoid the need for more invasive procedures, such as a surgical lung biopsy in the operating room with general anesthesia. It can remove secretions (mucus) that are interfering with breathing. Our skilled staff members at Asthma Allergy & Pulmonary Associates are ready to answer your questions and help you. You can contact our office to speak with our staff or to make an appointment by calling 215-923-7685.