Bronchoscopy

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How is the Test Performed?

The pulmonologist (a lung specialist trained to perform a bronchoscopy) sprays a topical or local anesthetic in your mouth and throat. This will cause coughing at first, which will cease as the anesthetic begins to work. When the area feels "thick," it is sufficiently numb. Medications to relax you may be given through an IV, making you sleepy.

If the bronchoscopy is performed via the nose, an anesthetic jelly will first be inserted into one nostril. When it is numb, the scope will be inserted through the nostril until it passes through the throat into the trachea and bronchi.

Usually, a flexible bronchoscope is used. The flexible tube is less than 1/2-inch wide and about 2-feet long. As the bronchoscope is used to examine the airways of the lungs, your doctor can obtain samples of your lung secretions to send for laboratory analysis.

Saline solution can be introduced to flush the area and collect cells that may be analyzed by a pathologist or microbiologist. This part of the procedure is called a "lavage" or a bronchial washing. Usually, small amounts (5-10 cc, or 1-2 teaspoons) of saline are used.

In certain circumstances, a larger volume of saline may be used. In this procedure, called bronchoalveolar lavage, up to 300 cc of saline (20 tablespoons) are instilled into the airway after the bronchoscope has been advanced as far as possible and a small airway is completely blocked (temporarily) by the scope. Bronchoalveolar lavage is performed to obtain a sample of the cells, fluids, and other materials present in the very small airways and alveoli (air sacs).

In addition, tiny brushes, needles, or forceps can be introduced through the bronchoscope to obtain tissue samples from your lungs. Occasionally, stenting and laser therapies can be performed through the bronchoscope. A rigid bronchoscope is less commonly used, and usually requires general anesthesia.