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 fluids can be introduced to flush the area and collect cells that may be analyzed by a pathologist.

The transbronchial biopsy procedure is performed using a tiny forceps passed through a channel of the bronchoscope into the your lungs. You will be instructed to breathe out slowly as the pulmonologist obtains a small sample of lung tissue. This step is usually repeated until several samples of tissue have been obtained for analysis. Occasionally x-rays (chest fluoroscopy)are used during the bronchoscopy to help direct the forceps to the desired area of lung.

• Infant test or procedure preparation (birth to 1 year)
• Toddler test or procedure preparation (1 to 3 years)
• Preschooler test or procedure preparation (3 to 6 years)
• Schoolage test or procedure preparation (6 to 12 years)
• Adolescent test or procedure preparation (12 to 18 years)

Local anesthesia is used to relax your throat muscles, so there is the feeling of fluid running down the back of the throat and the need to cough or gag until the anesthetic takes over.

Once the anesthetic takes effect, there may be sensations of pressure or mild tugging as the tube moves through the trachea. Many patients experience the feeling of suffocation when the tube is in the throat (there is no risk of suffocation). If coughing occurs during the test, more anesthetic will be added.

An X-ray is often taken after the bronchoscope is removed. When the anesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 to 2 hours, then normal eating and drinking is allowed. It is common after a transbronchial biopsy to cough up small amounts of blood-tinged sputum for a day. The pulmonologist will give you instructions on who to phone should you cough up significant amounts of blood.

The trachea and bronchi normally appear pink and smooth and have minimal secretions and no foreign bodies, growths, obstructions, or infections. Tissue obtained from a transbronchial biopsy should have normal tissue from the lining of the bronchus and air sacks (alveoli) from adjacent to that bronchus.

• Bronchial abnormalities, tumors
• Endobronchial mass
• Adenoma (tumor)
• Infection with an organism such as:
  • Aspergillosis
  • Coccidiomycosis
  • Actinomycosis
  • Fungus infections
  • Histoplasmosis infections
  • Anaerobic bacterial infections
  • Tuberculosis or mycobacteria
  • CMV pneumonia
  • PCP (Pneumocystis pneumonia)
• Hypersensitivity pneumonitis (inflammation of the lungs related to allergy-type reactions)
• Rheumatoid lung disease
• Vasculitis
• Alveolar abnormalities
  • Alveolar proteinosis
• Granulomas
  • Non-necrotizing granulomatous inflammation
  • Necrotizing granuloma (granular tumor)
  • Caseating granulomas
  • Sarcoidosis
  • Peribronchial granulomas

A small pneumothorax (popped lung) occurs in about 2% of transbronchial biopsies. Usually this is just followed with repeated chest X-rays unless the pneumothorax is large enough to require insertion of a chest tube to decompress the lung.

When a biopsy is taken, there is a risk of hemorrhage. Some bleeding is common; however, the technician or nurse will monitor the amount of bleeding.

Lung infection can occasionally occur after any bronchoscopy

There is also a small risk of:

• Disordered heart rhythm (arrhythmias)
• Heart attack
• Low blood oxygen (hypoxemia)

If general anesthesia is used, there is some risk of:

• Nausea
• Vomiting
• Sore throat
• Muscle pain
• Breathing difficulties
• Depressed heart rate
• Change in blood pressure

There is a small risk of:

• Heart attack
• Kidney damage

There is a significant risk of choking if anything (including water) is ingested before the anesthetic wears off.

To test if the gag reflex has returned, place a spoon on the back of your tongue for a few seconds with light pressure. If there is no gagging, wait 15 minutes and it attempt again. Make sure that no small or sharp objects are used to test this reflex. Phone your doctor or go to an emergency room immediately if you have shortness of breath or chest pain after this procedure.