There is no single test to diagnose pulmonary fibrosis (PF) and a battery of tests often are required to reach an accurate diagnosis. One such test is a bronchoscopy that is used to look inside the airways. It involves inserting a small tube with a light at the end through a patient’s nose or mouth, down the throat into the trachea or windpipe, and down to the bronchi and bronchioles of the lungs.

This procedure is used to identify the cause of lung problems. It may detect tumors, signs of infection, excess mucus in the airways, and bleeding or blockages in the lungs. Your doctor also may request a bronchoscopy to take samples of mucus or tissue to send to the laboratory.

How does bronchoscopy work?

The procedure is performed either with a flexible bronchoscope (most common) or a rigid bronchoscope.

Before the procedure begins, you will be given some relaxant medicine as well as a “numbing” spray so you don’t feel the tube going down your nose and throat. If you have low blood oxygen levels you will be given some extra oxygen during the bronchoscopy. Normal arterial oxygen is between 75 mm and 100 mm of mercury (Hg). Values below 60 mm Hg usually indicate the need for supplemental oxygen.

The insertion of the bronchoscope is likely to make you cough, but the numbing spray should calm the urge to cough. Your doctor will send saline solution through the tube to wash the lungs and allow the physician to collect samples of lung cells or fluids. This is the part of the procedure is called “lavage.”

Your doctor might use brushes, stents or other tools to take small tissue samples (if a biopsy is necessary) from your lungs. Your doctor also may use ultrasound during the procedure, which is a painless imaging technique that allows physicians to see inside the body.

If you have bleeding in your lungs, or if a large object is stuck in your airways, you might need a rigid bronchoscopy. For that procedure, you will have to be treated at a hospital and undergo general anesthesia.

How to prepare for a bronchoscopy?

When preparing for a bronchoscopy, you probably will be told not to eat or drink anything for six to 12 hours before the test, and not to take aspirin, ibuprofen or other blood-thinning drugs. You should ask your doctor when to stop taking these drugs. It is a good idea to arrange a ride to and from the hospital or clinic, as well as to get help with work, child care or other tasks, as you will need to rest afterward. If you have a rigid bronchoscopy at the hospital, consider extending this resting period.

What are the risks of bronchoscopy?

After the procedure, whether it is a flexible or rigid bronchoscopy, you will have to be monitored to check for potential complications. Common complaints include a sore throat, cough or hoarseness. All should subside with time.

If you have a flexible bronchoscopy in an outpatient facility you might be discharged after a couple of hours but, again, you probably will need to ask someone to take you home as the effects of the medicines might still impair your ability to drive or walk home alone. Your doctor will ask you to follow up after the procedure, to discuss the results.

Generally, bronchoscopy is considered a safe procedure and there is only a small risk of fever, minor bleeding or pneumonia. Pneumothorax, or the collapse of the lung, is a rare, but serious, side effect that is treatable. You also may require a chest X-ray to check for lung problems or complications.

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