Bronchoscopy is a lung procedure that allows the physician to look directly into the bronchi and to obtain samples or biopsies of any abnormalities found in the bronchial tree. Bronchoscopy is said to be diagnostic when it is carried out to assist physicians in investigating a lung abnormality. A bronchoscopy is therapeutic when performed to remove excess lung secretions or to retrieve aspirated (inhaled) foreign bodies. There are two types of bronchoscopes (the instruments used to perform bronchoscopy): flexible bronchoscopes and rigid bronchoscopes. Flexible bronchoscopy is also called flexible fiberoptic bronchoscopy, or FOB. Pulmonologists perform FOB, as do thoracic (chest) surgeons.
FOB is usually per-formed with the patient sedated but breathing on his or her own. The bronchoscopist passes the bronchoscope instrument (or scope, for short) through the nose or the mouth, through the vocal cords, and into the trachea. From there, the bronchoscopist can enter and visually inspect the main bronchi and all narrower divisions.
The scope enters the lung passages the same way air does. The scope has a light at its tip, as well as a channel, through which the bronchoscopist can inject local numbing medication, pass biopsy tweezers, and suck up any secretions. FOB is often used diagnostically in the investigation of masses or abnormalities seen on chest X-ray studies.
A rigid bronchoscopy is always performed in the operating room by a thoracic (chest) surgeon with the patient unconscious under anesthesia. The rigid bronchoscope is larger and less maneuverable than the flexible scope. It is considered superior to the flexible scope in two specific settings: when dealing with bleeding within the lung, and when retrieving larger aspirated (inhaled) foreign bodies. It also allows for the placement of bronchial stents in specialized circumstances. Most rigid broncho-scopies are indicated for therapeutic purposes. Bronchoscopy is not routinely performed in the care of someone with asthma.
Rare situations involving very severe asthma, when marked accumulation of mucus extensively blocks the bronchial passages, can require bronchoscopy to remove the thick, obstructing mucus plugs. A novel approach to treating persons with the most severe forms of asthma, bronchial thermoplasty, is currently undergoing a multinational clinical trial (as reviewed in Question 72) and is a procedure performed through a flexible fiberoptic bronchoscope directly targeting the airway smooth muscle. Having well-controlled asthma is not a contraindication to undergoing bronchoscopy if it is required for evaluation of another (non-asthma) lung condition.
It is important that a patient’s asthma be quiescent and inactive when the bronchoscopy is performed. In particular, if a person scheduled to undergo bronchoscopy is wheezing, the procedure should be cancelled and the wheezing brought under control before proceeding with the test.