Currently, there are many ways to study diseases. respiratory tract. Bronchoscopy is a procedure that allows you to carefully examine the lungs using a thin tube (bronchoscope).

The device has a light and small camera, which provides images of the mucous membranes of organs. The tube is placed in the nose or mouth. Then it smoothly descends into the throat, trachea and respiratory tract. After this, the medical professional examines the lumen of the large or small branches of the organ.

What is the essence of the procedure?

There are two types of bronchoscopes - flexible and rigid. Both come in different widths:

1. Flexible bronchoscope is used more often. It can move deep down into smaller branches - bronchioles. Typically used for:

• oxygen access;
• absorption of secretions (fluid, mucus, sputum);
• placing medicine into organs.

1. Hard tube device used to view wide air routes. It is advisable to use it for the following purposes:

• removing large amounts of secretions or blood;
• bleeding control;
• liberation respiratory system from foreign objects (especially in children).

The diagnostic test is performed in a hospital operating room under anesthesia.

Indications for bronchoscopy

The diagnostic method intended for the following cases:

• benign bronchial tumors;
• diagnostics;
• blockage of the airways (obstruction);
• narrowing of the area in the bronchopulmonary system;
• detecting inflammation and infections such as tuberculosis;
• interstitial diseases;
• research into the causes of persistent cough and hemoptysis;
• clarifying the diagnosis when spots are reflected on an x-ray chest;
• vocal paralysis.

How do they do it?

It is advisable for patients to provide a sputum sample for analysis 3 days before the procedure. At oncological diseases Bronchoscopy is used as follows:

• a flexible tube is used to remove tissue samples (biopsies) and in the case of laser therapy;
• The affected tissue is removed using a rigid tube.

What does modern brochoscopic diagnostics include?

To provide a detailed picture, advanced imaging studies are sometimes performed, such as:

1. One-time CT scan.
2. Fluorescent endoscopic images. In this case, a special device is connected to a computer and tissues are visualized using fluorescent light attached to the bronchoscope.
3. Endobronchial ultrasound: a special sensor is attached to the device and depicts the bronchopulmonary tract.

Such diagnostic methods are effective for:

• early detection of malignant tumors, in particular;
• determining the number of areas of moderate and severe dysplasia;
• high-quality immunohistochemistry - one of the most accurate modern diagnostic tests for malignant disease, which is based on determining the characteristics of tumor behavior at the cellular level;
• predicting the further development of the oncological process based on the state of the layer lining the lungs.

Risks

In general, the diagnostic method is safe, but there are some possible complications:

• bleeding, especially during biopsy;
• the occurrence of an infectious disease;
• labored breathing;
• low level of oxygen in the blood during the procedure.

Performing bronchoscopy of the lungs

Situations in which bronchoscopy of the lungs is prohibited

• severe narrowing or blockage of the trachea (stenosis);
• high blood pressure in the blood vessels of the lungs (pulmonary hypertension);
• severe cough or pronounced gag reflex.

If a person has high level carbon dioxide in the blood (hypercapnia), he may need a breathing machine before the procedure. This is done to ensure that oxygen is sent directly to the lungs.

Bronchoscopy - how is it done? Types and indications for research

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is bronchoscopy?

Bronchoscopy is a research method with which the lumen and mucous membrane of the bronchi are examined. Bronchoscopy refers to endoscopic research methods and can be carried out for both therapeutic and diagnostic purposes.

Endoscopic research methods are methods that allow us to examine organs that have at least some minimal cavity ( "endo" means inside, and copy means to explore.) Thus, the purpose of endoscopic methods is to examine the internal cavity of the organ. When carrying out these diagnostic methods, rigid and flexible instruments are used ( endoscopes). The first includes metal tubes of various diameters, and the second includes fiber optics devices. At the end of the endoscope there is a light bulb that illuminates the cavity being examined, and a video camera that is connected to the monitor. When performing bronchoscopy, flexible endoscopes are used ( synonym - fiberscope), which made a real revolution in medicine. They consist of many glass fibers ( LEDs) through which the image is transmitted. Due to the phenomenon of total reflection at the boundary of two media, the resulting picture is highly informative. During bronchoscopy, a fiberscope is inserted into the bronchi through natural openings, that is, through the nose or mouth.

How is bronchoscopy done?

Bronchoscopy allows you to identify pathologies localized at the level of the lower respiratory tract - the trachea, main bronchi and bronchioles. In order to understand what exactly bronchoscopy examines, you need to know the structure bronchial tree.

Anatomy of the bronchi and bronchial tree
The human lower respiratory tract consists of the trachea, the main ( right and left) bronchi and bronchial tree. The trachea or windpipe is divided into right and left main bronchus. Secondary bronchi depart from them, which, in turn, are divided into small branches, and those into even smaller ones. The set of all secondary bronchi and their branches is called the bronchial tree. Thus, conditionally, the lower respiratory tract can be expressed as follows. Trachea – left and right main bronchus – secondary bronchi – bronchial tree. During bronchoscopy, the fiberscope examines the trachea, main and secondary bronchi, then it passes into the middle and small branches of the bronchi. However, the fiberscope cannot penetrate the smallest bronchioles due to their small diameter. To study smaller branches, other diagnostic methods are used, for example, virtual bronchoscopy.

Bronchoscopy method

When performing bronchoscopy, the patient should be in a supine position. Most often, an additional towel roll is placed under the shoulders. Routine therapeutic bronchoscopy is performed in the morning, on an empty stomach. If bronchoscopy is performed for emergency reasons, then, of course, the time of day does not matter. Anesthesia, that is, pain relief, is administered 5–10 minutes before the start. Anesthesia is a mandatory part of both planned and emergency bronchoscopy. She not only films painful sensations in the patient, but also suppresses the cough reflex, which could interfere with the procedure. Most often, the anesthetic is used in the form of a spray or aerosol.

A fiberscope is inserted through the nose or mouth, which passes into the larynx, and from it into the trachea and bronchi. Through an eyepiece connected at the other end, the doctor examines the passing paths. Further tactics depend on the purpose of bronchoscopy. For aspiration ( ventilation) pathological fluid in the bronchi or sanitation ( washing) of the purulent cavity, a special aspiration tip is inserted into the lumen of the bronchi, through which the liquid is sucked out. If the purpose of bronchoscopy is to wash the bronchial tree, then a solution for washing the bronchial tree is first introduced through the fiberscope tube ( it could be a solution of furatsilin). The liquid is introduced in small portions and then removed. By alternating the processes of fluid administration and aspiration, sanitation is carried out ( simple rinsing) bronchi.

When removing a foreign body from the bronchi, special forceps are used that grasp the object ( it could be a pea, bean) and remove it. For bronchial bleeding, a procedure called bronchial tamponade is used. In this case, take a piece of foam rubber, which should be twice the diameter of the bronchi. It is rolled up tightly, moistened in an antiseptic solution and placed in the cavity of the bronchus, thus closing its lumen. In order to insert this foam into the bronchus, hard forceps are used, which are passed through a fiberscope. When the fiberscope reaches the bleeding site, the forceps unclench, and the foam expands and fills the lumen. In this “compacted” state, the foam rubber remains in the lumen of the bronchial tree until the bleeding stops.

If the bleeding is minor, then instead of tamponade, irrigation of the bleeding vessel with a solution of adrenaline can be used. Adrenaline is a substance that causes a sharp constriction of blood vessels and stops bleeding ( if the vessel is small).

Preparing for bronchoscopy and performing the procedure

Proper preparation for bronchoscopy allows for an informative procedure with minimal negative consequences. The purpose of the preliminary measures is to eliminate both emotional and physiological factors that may interfere with this study.

Preparation for bronchoscopy includes the following activities:

• conducting medical examinations;
• preliminary medical consultation;
• psychological preparation of the patient;
• maintaining a special diet;
• taking sedatives;
• performing a series of actions immediately before the procedure.

Conducting medical examinations

To exclude possible contraindications and determine the optimal method of bronchoscopy for the patient, a series of examinations should be completed before the procedure.

Preparation for bronchoscopy involves the following studies:

• X-ray of the lungs. To get a picture of the lungs ( radiography), a beam of X-rays is passed through the chest and then imaged on film. Since bones absorb radiation, they appear white in the image, while air cavities appear black. Soft fabrics are indicated in gray on the radiography. Based on the image, the doctor sees the location of pathological foci and subsequently pays special attention to them during bronchoscopy.
• Cardiogram. The examination is carried out in order to obtain a graphical display of the work of the heart. Special electrodes are installed on the patient's chest, arms and legs, which monitor the heart rhythm and transmit it to a computer, where the data is compiled into a cardiogram. In order for the examination to be as informative as possible, the patient should not eat 2–3 hours before the procedure. Using the cardiogram, the doctor determines whether there is a risk of negative consequences for the heart during bronchoscopy.
• Blood analysis. To exclude the possibility of infectious processes and other diseases that could become an obstacle to bronchoscopy, the patient is prescribed blood tests. For biochemical analysis blood is taken from a vein, for general purposes - from a finger or also from a vein. For the results to be reliable, the analysis must be performed on an empty stomach, which requires not eating 8 hours before the procedure. It is also recommended to give up alcohol and fatty foods for 1–2 days.
• Coagulogram. To conduct this study, blood is taken from the patient's vein, which is then tested for clotting. A coagulogram is prescribed to eliminate the risk of bleeding during and after bronchoscopy. As with other blood tests, the patient must not eat 8 hours before the procedure and not consume alcoholic beverages or high-fat foods for 1–2 days.

Preliminary medical consultation
After receiving data on all prescribed preliminary examinations, the patient is sent to a doctor who will perform bronchoscopy. Before the procedure, a preliminary consultation is indicated, during which the patient will be explained what he needs to do before and after the lung examination. A person undergoing bronchoscopy should inform the doctor whether he is taking any medications whether he suffers from allergies, whether he has previously suffered from anesthesia. This information will help the doctor choose the optimal procedure for the patient.

Psychological preparation of the patient
The emotional state has a great influence on the quality of bronchoscopy and the results obtained. During the procedure, the patient should be relaxed and calm, since otherwise it will be difficult for the doctor to carry out the necessary manipulations with the bronchoscope. The best way to help the patient calm down is to become familiar with all aspects of the procedure. To get a complete picture of how bronchoscopy is performed, the patient should, during the preliminary consultation, ask the doctor all the questions that concern him. The duration of the procedure, the nature of the sensations before and after bronchoscopy, the type of planned anesthesia - these and other questions that the patient may have must be discussed with the doctor.

In addition to medical consultation, the patient should also independently work on his emotional state. To put your mind at ease, it is recommended to think about the fact that bronchoscopy significantly speeds up the healing process, regardless of the purpose for which it is performed ( diagnostic or therapeutic). You should also take into account the fact that there are no pain receptors in the bronchial mucosa. Therefore, discomfort during bronchoscopy is more due to psychological than physical factors. The day before the examination, it is not recommended to watch films or programs of a negative nature. Also, if possible, you should limit the influence of various household or professional stress factors.

Following a special diet before bronchoscopy

Bronchoscopy is performed on an empty stomach, so the last meal should be at least 8 hours before the procedure. Since lung examinations are most often scheduled for the morning, the last meal of the day is dinner, after which even light snacks are prohibited. Dinner should consist of foods that are quickly digested and easily digested. It is recommended to give preference to vegetables, lean meat or fish. To avoid discomfort during the procedure, you must avoid foods that contribute to excess gases in the intestines.

There are the following food products that cause gas formation:

• any legumes;
• all varieties of cabbage;
• radish, turnip, radish;
• mushrooms, artichokes;
• apples, pears, peaches;
• milk and any products made from it;
• all drinks that contain gases.

A prerequisite is to abstain from any alcoholic beverages the day before bronchoscopy. On the day of the examination, you need to stop smoking, as using tobacco products increases the risk of complications. You should also not drink coffee, cocoa or any caffeinated drinks.

When performing bronchoscopy, the patient's intestines must be empty. Otherwise, due to intra-abdominal pressure, involuntary emptying may occur during the procedure. Therefore, in the morning, before visiting the clinic, you should empty your bowels. In some patients, due to anxiety or peculiarities gastrointestinal tract difficulties arise with morning bowel movements. In such cases, the patient is prescribed a cleansing enema.

Taking sedatives
To reduce anxiety, most patients are prescribed sedatives before bronchoscopy ( calming) actions. These medications should be taken in the evening, the day before the examination. In some cases, repeated use of sedatives is indicated, 1 to 2 hours before the procedure.

Performing a series of actions immediately before the procedure
Before the bronchoscopy, the patient must visit the toilet to empty the bladder. If a person has jewelry on the neck or on such parts of the body as the nose, tongue, lips, they must be removed, as they will prevent the doctor from carrying out the necessary manipulations. The bronchoscope can be obstructed by braces and other devices that are attached to the teeth, so if possible, these should also be removed.

Bronchoscopy results

Diagnostic bronchoscopy reveals only endobronchial manifestations inflammatory process, that is, those changes that are located inside the bronchial tree. The changes identified in this case are most often designated by the term “endobronchitis” ( endo means inside). Depending on the degree and extent of the changes, several types of endobronchitis are distinguished.

Types of endobronchitis are:

• catarrhal endobronchitis– characterized only by redness and swelling of the bronchial mucosa;
• atrophic endobronchitis– manifested by thinning and dryness of the mucous membrane, but at the same time the cartilaginous pattern is enhanced;
• hypertrophic endobronchitis– characterized by thickening of the mucosa, which leads to a uniform narrowing of the lumen of the bronchi;
• purulent endobronchitis– the main symptom is purulent discharge accumulating in the lumen of the bronchi;
• fibrous-ulcerative endobronchitis– characterized by the formation of ulcerative lesions on the mucosa, which are subsequently replaced by fibrous tissue.

With the exception of certain cases ( cancer, fistulas and foreign bodies) Bronchoscopy diagnoses inflammatory changes in the bronchi. To evaluate them, the doctor carefully examines the mucous membrane through a fiberscope, or rather, through a camera connected to it. As a rule, the data obtained during bronchoscopy is transmitted to a video monitor. The image obtained on the screen gives a more complete assessment of the mucous membrane. Also, no less important, it can be enlarged several times and get a more detailed image. In order to accurately assess the nature of the inflammatory lesion, the doctor can take a piece of the mucous membrane for further study in the laboratory. This procedure called a biopsy.

In addition to inflammatory changes, bronchoscopy can diagnose a violation of the tone of the bronchial tree. As a rule, hypotonic dyskinesia is diagnosed, which is characterized by an increase in respiratory mobility and collapse of the bronchi during exhalation.

Due to the proliferation of tumor tissue or frequent inflammatory changes, the lumen of the bronchi may narrow. This is also visible on bronchoscopy. In this case, the doctor performing the bronchoscopy can assess the degree of narrowing. In the first degree, the lumen is narrowed by no more than one-eighth, in the second degree - by half, and in the third degree - by more than two-thirds.

Types of bronchoscopy

As already mentioned, bronchoscopy can be performed for therapeutic or diagnostic purposes. In the first case, the doctor may irrigate the bronchial tree, administer medications, or remove foreign objects. In the second case, bronchoscopy is performed to assess the condition of the mucosa or take a biopsy.

Types of bronchoscopy include:

• therapeutic bronchoscopy;
• diagnostic bronchoscopy;
• virtual bronchoscopy.

Therapeutic bronchoscopy of the lungs

Therapeutic bronchoscopy of the lungs is a type of intervention in which any pathology is eliminated or introduced medicinal substance. As with any study, there must be indications for bronchoscopy. As a rule, this is a suspicion of a foreign body, washing, stopping bronchial bleeding.

Indications for therapeutic bronchoscopy include:

• lavage of the bronchial tree;
• washing and draining the purulent cavity;
• removal of foreign bodies – most often in children;
• clearing airway blockages that may be caused by mucus or pus;
• treatment of fistulas.

Also, therapeutic bronchoscopy can be performed to stop bronchial bleeding or to administer drugs directly into the bronchial cavity. The latter maneuver is usually performed in the treatment of bronchial asthma.

Like any study, therapeutic bronchoscopy also has contraindications.

Contraindications to therapeutic bronchoscopy are:

• second and third degree arterial hypertension;
• serious condition of the patient;
• exudative pleurisy;
• aortic aneurysm;
• pathology of the larynx ( for example, tuberculosis);
• mediastinal tumors.

At the same time, the doctor must take into account both indications and contraindications. For example, if a patient has a foreign object in the respiratory tract, then bronchoscopy will be performed anyway, since otherwise it will be fatal.

Diagnostic bronchoscopy

Diagnostic bronchoscopy is performed to identify pathology. Using this diagnostic method, it is possible to detect inflammatory or scarring lesions of the mucous membrane of the bronchial tree. Bronchoscopy also reveals tumors, stenoses ( narrowing), fistulas. During this procedure, a biopsy can also be taken ( a piece of tissue that is further examined under a microscope).

Indications for diagnostic bronchoscopy are:

• suspected lung cancer;
• tuberculosis;
• persistent, prolonged cough;
• pathological changes in lung tissues that were identified on x-ray;
• smoking for more than 5 years;
• decline ( atelectasis) lung.

However, as with therapeutic bronchoscopy, there are contraindications for diagnostic bronchoscopy. As a rule, they are limited to pathologies of the heart and blood vessels. This is explained by the fact that during bronchoscopy, blood pressure rises sharply, which can complicate existing pathologies.

Contraindications for diagnostic bronchoscopy include:

• exacerbation of bronchial asthma;
• recent myocardial infarction;
• heart rhythm disturbance in the form of blockade or arrhythmia;
• heart failure or pulmonary failure;
• mental and neurological diseases, such as epilepsy;
• condition after traumatic brain injury.

Diagnostic bronchoscopy is performed, as well as therapeutic one. A mandatory item is anesthesia, which allows you to weaken the muscles of the bronchi, eliminate the cough reflex and eliminate pain in the patient. After preliminary anesthesia and correct positioning of the patient ( he lies on his back) through oral cavity A fiberscope is inserted into the larynx. Then, with smooth movements, it is pushed into the trachea, and from it into the left or right bronchus.

Virtual bronchoscopy

Virtual bronchoscopy is a method that examines the bronchi without resorting to the use of a probe. That is why virtual bronchoscopy does not belong to endoscopic diagnostic methods, but is a variant of computed tomography.

Virtual bronchoscopy is based on the X-ray method. Rotating, the X-ray tube produces an image, which is subsequently converted into three-dimensional. Thus, using a special program, a complete image of the entire bronchial tree is reconstructed ( main and small bronchi). In this case, all layers of the bronchi, including the mucous membrane, are visible in the picture. The advantage of this method is the ability to examine even the smallest bronchi, which cannot always be seen with conventional bronchoscopy.

Pros and cons of virtual bronchoscopy

Minuses	pros
The diagnostic value is lower than with conventional bronchoscopy - it is not possible to take a biopsy ( piece of material for research).	Highly informative - virtual bronchoscopy allows you to see small caliber bronchi, from 1 to 2 millimeters.
The procedure cannot be carried out for therapeutic purposes, that is, it is impossible to pull out a foreign object or eliminate bleeding.	Much fewer contraindications. Contraindications include only third degree obesity and pregnancy.
The cost of the procedure is 2–3 times higher than conventional bronchoscopy.	Painless, non-traumatic.
Virtual bronchoscopy is limited in case of claustrophobia ( fear of closed spaces) and early childhood.	Does not require special preparation, duration is from 5 to 15 minutes ( the usual procedure takes about 30 minutes or more).
When performing virtual bronchoscopy, the patient receives a certain dose of radiation.	Even seriously ill patients can be diagnosed.

Bronchoscopy in children

Bronchoscopy in children can be performed as both a therapeutic and diagnostic procedure. Modern drugs for anesthesia allow for painless and safe procedures. This significantly increases the list of pathologies in young patients for which examination of the lungs with a bronchoscope is indicated.

The procedure is carried out to establish the true causes of certain diseases of the respiratory system. Using the device, the doctor can obtain a secretion ( slime) from deep-lying parts of the bronchial tree for further bacteriological research. This procedure can also involve tissue sampling ( biopsy) for subsequent analyses, removal of foreign objects or neoplasms. Bronchoscopy allows you to deliver drugs directly to the lesions, remove pathological mucus and carry out other healing procedures with a high therapeutic effect.

Indications for bronchoscopy in children

One of the most common reasons Carrying out this manipulation in children is the penetration of a foreign body into the respiratory tract. Parts of toys, caps from writing instruments, bones, buttons, coins - these and other small objects often end up in the respiratory system of young patients.

Another common reason for bronchoscopy is tuberculosis. The procedure is prescribed in order to confirm or refute the presence of changes in the bronchi or lungs characteristic of tuberculosis. Bronchoscopy is also indicated for obtaining mucus in order to identify the causative agent of the disease. In older children, tuberculosis can cause bleeding in the lungs, and in such cases a procedure is prescribed to stop this process. There are other pathological conditions for which bronchoscopy in children is indicated.

There are the following indications for bronchoscopy in children:

• developmental anomalies of the bronchopulmonary system;
• pulmonary atelectasis ( a pathology in which the lung ceases to participate in gas exchange);
• cystic fibrosis ( disease of mucus-producing organs, including the lungs);
• lung abscess ( the formation of a cavity filled with pus in the lung);
• expectoration of blood and/or pulmonary hemorrhage;
• neoplasms in the lungs;
• bronchial asthma ( chronic inflammation of the respiratory system);
• diseases of the lungs and bronchi of unknown origin.

Preparing a child for bronchoscopy

For this endoscopic procedure to be successful, parents need to prepare the child in accordance with a number of rules. Since bronchoscopy is performed under general anesthesia and the patient will not understand what is happening, in some cases adults are advised not to explain in detail what the procedure involves. However, if the child's age allows, he should be emotionally prepared for anesthesia so that he does not panic immediately before the anesthetic is administered.

List of preliminary examinations ( blood test, radiography, cardiogram) is determined by the doctor, who takes into account the child’s age, general condition and other factors. The child should not be fed 6–8 hours before bronchoscopy, and should not drink anything 3–4 hours before the bronchoscopy. Children who are breastfed can be fed for the last time 4 hours before the procedure.

Features of bronchoscopy in children

In most cases, this procedure for young patients is performed under general anesthesia. Inhalation anesthesia is indicated for children under 3 years of age ( mask anesthesia), in which the drug is administered through a special mask placed over the mouth and nose. Patients over 3 years of age can be given either mask or traditional anesthesia, which is administered intravenously. Bronchoscopy in children is carried out mainly with a flexible bronchoscope, the diameter of which is selected depending on the age of the child. Thus, patients under the age of one year are examined with a device whose tube does not exceed 3 millimeters in diameter. Children aged from one to 3 years are shown a bronchoscope, whose diameter does not exceed 6 millimeters.

During the procedure, the child is in horizontal position, which increases the likelihood of bronchospasm. Therefore, before performing pediatric bronchoscopy, medical personnel prepare necessary equipment for artificial ventilation of the lungs. After manipulation of the bronchoscope, the child must be prescribed antibiotics in order to prevent the development of infection.

Indications for bronchoscopy

Bronchoscopy is invasive ( violating the external barriers of the body - skin, mucous membranes) by research method, and therefore, despite its advantages, it is carried out according to strict indications. The main indications for bronchoscopy are pulmonary tuberculosis, bronchial cancer, and foreign bodies in the respiratory tract.

Bronchoscopy for tuberculosis

For tuberculosis, both diagnostic and therapeutic bronchoscopy is performed. The first option is carried out when the others bacteriological research negative or when sputum cannot be obtained for testing. In this case, bronchoscopy will allow not only to make the correct diagnosis, but also to prescribe adequate treatment. Another important advantage of bronchoscopy for tuberculosis is the ability to take a biopsy. Taking material for further research will allow us to identify chemoresistant forms of tuberculosis ( forms that cannot be treated with chemotherapy). Bronchoscopy also allows you to monitor the condition of the bronchi after or before surgery. Thus, tuberculosis often ends with resection ( deletion) part of the lung, after which observation is necessary. As mentioned above, bronchoscopy for tuberculosis is always accompanied by taking a piece of mucous membrane for examination, that is, a biopsy. The biopsy is performed with special forceps or using a scarifying brush. In the first case, the material for research is simply bitten off ( it takes a few seconds), and in the second case the material is scraped off ( brush biopsy method).

Bronchoscopy for lung cancer

If lung cancer is suspected, careful visualization is performed using bronchoscopy ( inspection) trachea and bronchi, including secondary bronchi. To examine small branches measuring a couple of millimeters, virtual bronchoscopy is performed. It is mandatory to collect material for histological and cytological examination. Only with the help of a biopsy can the diagnosis of cancer, as well as its type, be confirmed.

Sometimes the test may involve inserting catheters ( straws) into the small bronchi to obtain a smear. This procedure is called catheterization and is necessary to diagnose peripheral cancer. If cancer has already been confirmed and bronchoscopy is performed for observation purposes, then a biopsy of the lymph nodes is also required. It is necessary to determine metastases.

Bronchoscopy for bronchial asthma

Bronchoscopy for bronchial asthma may be prescribed to diagnose or treat a disease. In acute stages of the disease, the procedure is not performed, as it can cause exacerbation and deterioration of the patient’s condition.
If a child suffers from bronchial asthma, opinions on the advisability of bronchoscopy are divided. A number of experts classify this endoscopic procedure as mandatory, since it can be used to perform various highly effective manipulations. Others rarely resort to bronchoscopy, as they consider it unsafe for young children with this disease.

Despite the heterogeneity of opinions, it should be emphasized that at the moment, pulmonary bronchoscopy is one of the most accurate methods for establishing the correct diagnosis for suspected bronchial asthma. Also, in some cases, bronchoscopy is the only possible method of performing a particular treatment procedure.

Indications for bronchoscopy for bronchial asthma

First of all, this procedure is prescribed in order to confirm or refute existing assumptions about the presence of bronchial asthma in the patient. Bronchoscopy can also help determine the nature of the disease. So, if severe swelling with exudate penetration is detected ( liquid part of blood) deep into the walls of the bronchi, there is a high probability of atopic bronchial asthma. In cases where the patient coughs up mucus due to asthma, bronchoscopy is performed to collect and further examine the mucus. The presence in the sputum of a white secretion without pus, which contains many eosinophils ( a certain type of leukocyte) may indicate the allergic nature of the disease. This endoscopic procedure is also performed to rule out other possible causes of asthma symptoms.

Therapeutic bronchoscopy is prescribed to reduce symptoms and improve the patient’s well-being.

The following indications for therapeutic bronchoscopy for asthma are distinguished:

• lack of results from previous treatment;
• copious mucus secretion, when there is a high probability of developing bronchial obstruction;
• coughing up purulent contents;
• convergence and compression of the pulmonary walls, as a result of which air disappears from the lung bubbles and the organ is switched off from gas exchange.

Therapeutic bronchoscopy is performed to eliminate bronchial obstruction, as well as to reduce the inflammatory process by exposing the mucous membrane to various drugs. In some patients, lavage is performed using a bronchoscope, followed by suctioning of the contents.

Features of bronchoscopy for asthma

Before bronchoscopy, a patient with asthma is prescribed sedatives ( sedatives) drugs that are taken in the evening, on the eve of the procedure. 40 minutes before the procedure, a medicine with anticonvulsant and anti-anxiety effects is administered intramuscularly. This may be atropine, diphenhydramine or seduxene. After 20 minutes, the patient is given aminophylline or another drug that dilates the bronchi and relieves spasms. Immediately before the procedure, the patient should use an aerosol ( Berotec, salbutamol) to prevent bronchial spasm. Subsequently, the procedure is carried out using the standard method.

Consequences and complications of bronchoscopy

After bronchoscopy, the patient may experience a number of unpleasant sensations, the cause of which is the anesthesia and manipulations performed. In some rather rare cases, pulmonary endoscopy is accompanied by complications that can appear both during the procedure and after it.

Consequences of bronchoscopy
Typically, patients complain of difficulties that arise in the process of swallowing, the sensation of a foreign body in the throat, and numbness of the pharynx. In some cases, after the procedure, small blood clots may be present in the coughed up mucus. Blood appears because during bronchoscopy the device injures the mucous membrane of the respiratory tract. Also, some patients have temporary nasal congestion. To reduce discomfort and prevent the development of more serious complications, people should follow certain rules after bronchoscopy.

• You should not eat or drink water until the effect of the anesthetic wears off ( The doctor will tell you the exact time);
• while the anesthesia continues to act, saliva should be spat out and not swallowed, because otherwise the patient may choke;
• You should stop smoking for 24 hours after the procedure;
• before the first meal, you need to take a small sip of water to check whether the sensitivity of the pharynx has been restored;
• the patient is not recommended to drive until the end of the day;
• During the day after bronchoscopy, it is prohibited to drink any alcohol or hot drinks;
• Ice cream and other types of cold foods/drinks should not be consumed within the next 24 hours.

Complications of bronchoscopy

Complications caused by bronchoscopy can be divided into two groups. The first category includes negative changes in the patient’s condition that develop during the procedure. The second group includes complications that arise after bronchoscopy.

Complications that occur during the procedure may be caused by the drugs used for anesthesia. If you are allergic to local or general anesthesia, the patient may experience seizures or develop anaphylactic shock. A sharp drop in blood pressure, breathing problems, and heart rhythm disturbances are also possible.
It should be noted that allergic reaction anesthesia occurs in rare cases, and the direct presence of a doctor allows you to quickly normalize the patient’s condition. Another cause of complications during the procedure may be damaged blood vessels, which causes bleeding. The likelihood of bleeding is highest when a biopsy is performed during bronchoscopy ( pinch off a fragment of the lung or bronchi with forceps).

Factors that provoke complications after the procedure can be various infections or mistakes made during bronchoscopy.

There are the following complications that develop after bronchoscopy:

• Pneumothorax. With this pathology in the pleural cavity ( space under the outer lining of the lungs) air appears, which compresses the lung, as a result of which the organ ceases to participate in the breathing process. This complication develops due to damage to the pleura by the bronchoscope or forceps used to perform the biopsy. Pneumothorax is manifested by sharp pain in the chest, which becomes stronger with inspiration and can radiate to the shoulder. The patient's breathing becomes rapid and shallow, and a dry cough is possible. The heart rate quickens, sweat appears on the skin, and general weakness develops.
• Bacteremia. If there is an infectious process in the respiratory tract and damage to the integrity of the bronchi during the procedure, infectious agents enter the blood and bacteremia develops. This pathology manifests itself with such symptoms as chills, nausea, vomiting, general weakness and apathy.
• Perforation of the bronchial wall. It is one of the rarest complications and occurs when various sharp objects are removed from the patient’s respiratory tract ( wire, nails, pins). Symptoms of a violation of the integrity of the bronchi are coughing, expectoration of blood ( not always), severe chest pain.
• Inflammation of the bronchi and lungs. When an infection enters the respiratory tract, the patient may develop complications such as bronchitis and pneumonia. Signs of inflammation are chest pain, fever, and cough.

Prices for bronchoscopy

The cost of bronchoscopy determines both the method of performing the procedure and the location in which it is performed.

The following factors determine the cost of bronchoscopy:

• Method of carrying out the procedure. Thus, a standard endoscopic examination costs significantly less than a virtual one ( computer) bronchoscopy. In the case of conventional bronchoscopy, the price may also vary depending on which device ( hard or flexible) research is being carried out.
• Institution. The location of the clinic, namely the distance from the city center or from public transport stops, sometimes plays a large role in determining the cost of this procedure. Also influenced by the quality of equipment, the competence of specialists and other factors that determine the prestige of a medical institution.
• Additional manipulations. The cost of the anesthesia used may determine the price of the bronchoscopy. In most cases, a procedure using local anesthetics will cost the patient less. Additional manipulations also include performing a biopsy and subsequent cytological examination.

On average, the cost of a standard bronchoscopy varies from 2,000 to 6,000 rubles. The price of virtual bronchoscopy can reach 7,000 – 9,000 rubles. In some institutions, the price of such a procedure exceeds the average value several times. So, in the capital European medical center On Shchepkina Street, bronchoscopy costs 23,000 rubles. The difference in price is explained by the foreign equipment that the center is equipped with and other factors that emphasize the prestige and professionalism of the clinic.
For the convenience of Internet users, catalog websites have been created that provide detailed information about various clinics specializing in this procedure. In addition to the address and operating hours, many resources also indicate the approximate cost of the procedure, which allows you to choose best option with minimal time costs.

Sign up for a study

To make an appointment with a doctor or diagnostics, you just need to call a single phone number
+7 495 488-20-52 in Moscow

+7 812 416-38-96 in St. Petersburg

The operator will listen to you and redirect the call to the desired clinic, or accept an order for an appointment with the specialist you need.

Prices for bronchoscopy in Moscow and other Russian cities

A procedure such as endoscopy in the capital is offered by many different medical institutions. Special online catalogs contain detailed information about clinics in the capital and other settlements. Such sites indicate prices, addresses, opening hours and other information for choosing a suitable diagnostic center. Some resources, in addition to basic information, indicate real reviews people who underwent bronchoscopy, as well as photographs of the interior, personal data of specialists.

Facilities that offer bronchoscopy

City	Name of institution	Address	Telephone	Website
Moscow	Clinic "Be Healthy"	Komsomolsky Prospekt, 28	(495 ) 782-88-82	clinicbudzdorov.ru
	Medical center "MEDLUX"	Sirenevy Boulevard, 32a	(499 ) 704-49-26
	Center "Best Clinic"	Nizhnyaya Krasnoselskaya street, house 15/17	(499 ) 519-34-75
Saint Petersburg	Clinic "Admiralty Shipyards"	Sadovaya street, house 126	(812 ) 409-90-18
	Research Institute of Oncology named after Petrov	Pesochny village, Leningradskaya street, house 68	(812 ) 243-19-60
	Clinic named after Peter the Great	Piskarevsky prospect, house 47	(812 ) 303-50-60
Novosibirsk	Almita Medical Center	Zheleznodorozhnaya street, building 12/1	(383 ) 363-06-31
	Medical Center "A"	Rimsky-Korsakov street, building 19	(383 ) 346-00-70
	Clinic "Sanitas"	Vokzalnaya Magistral street, building 16	(383 ) 233-66-00
Kazan	Republican Hospital	Orenburgsky tract, house 138	(843 ) 231-21-09
	Hospital No. 7	Marshal Chuikov street, building 54	(843 ) 237-91-71
	Maternity hospital No. 16	Gagarina street, house 54	(843 ) 560-66-52
Ufa	Emergency Hospital	Batyrskaya street, house 39/2	(347 ) 255-66-71	bsmp-ufa.rf
	Clinic of the Bashkir State Medical University	Shafieva street, building 2	(347 ) 223-11-92
	Republican Hospital named after Kuvatov	Dostoevsky street, house 132	(347 ) 279-03-97

Bronchoscopy (synonym: tracheobronchoscopy) is a method of examining the inner surface of the trachea and bronchi using special optical instruments - bronchoscopes. Bronchoscopy can be both diagnostic and therapeutic. During diagnostic bronchoscopy, doctors monitor the condition of the lungs and bronchi. Therapeutic is carried out to remove foreign bodies or pathological contents of the bronchi; this method can also be used to administer medications.

Types of bronchoscopy:

• Rigid (rigid) bronchoscopy is performed using a rigid bronchoscope. This procedure allows you to detect foreign bodies in the respiratory tract, and it is also used for bleeding of the respiratory system. Rigid bronchoscopy is performed under general anesthesia.
• Flexible bronchoscopy is performed using an elastic fiberoptic bronchoscope. This procedure is the most common because it does not require anesthesia. It is performed under local anesthesia. Flexible bronchoscopy allows you to examine the inner surface of the upper respiratory tract.

Indications for diagnostic bronchoscopy:

• tuberculosis;
• suspected lung cancer;
• pulmonary atelectasis;
• smoker experience for more than 5 years;
• hemoptysis;
• obstructive pulmonary diseases;
• persistent cough without obvious reasons;
• suspected pulmonary infections;
• pathological changes identified as a result of an X-ray examination of the lungs - nodules, compactions, inflammatory processes.

Indications for therapeutic bronchoscopy:

• removal of foreign bodies from the respiratory tract;
• removal of a tumor blocking the airways;
• installation of a stent in one of the airways due to compression by a tumor.

Absolute contraindications:

• myocardial infarction suffered less than six months ago;
• intolerance to drugs used for local anesthesia;
• heart rhythm disturbance;
• acute stroke;
• stenosis of the larynx and/or trachea;
• hypertonic disease;
• exacerbation of bronchial asthma;
• cardiovascular or pulmonary heart failure;
• pain syndrome V abdominal cavity;
• neuropsychiatric diseases (schizophrenia, epilepsy, etc.);
• condition after traumatic brain injury;
• serious condition of the patient in a case where clarification of the diagnosis will no longer affect treatment.

Inflammatory changes in the bronchi

Inflammatory changes in the bronchi are among the most common manifestations of lung diseases detected during bronchoscopy. Assessment of inflammatory changes is made based on the study of the condition of the mucous membrane, as well as the nature and amount of bronchial secretion. Depending on the prevalence of inflammatory changes, endobronchitis can be unilateral or bilateral, diffuse or limited.

There are 3 degrees of inflammation intensity. In the first of them, the mucous membrane of the bronchi is pale pink, covered with mucus, does not bleed, the ridge of the tracheal bifurcation is sharp, the cartilaginous rings are prominent. In the second, the mucous membrane is bright red, thickened, sometimes bleeding, the secretion on it is mucous or mucopurulent, the interbronchial spurs are thickened, which makes it difficult to examine the peripheral bronchi, the cartilaginous rings are poorly differentiated. In the third degree, the mucous membrane of the trachea and bronchi is purple-bluish, thickened, bleeds easily, covered with purulent secretion, the ridge of the tracheal bifurcation is thickened. Cartilaginous rings are not differentiated. The orifices of the lobar bronchi are sharply narrowed due to swelling of the mucous membrane. The abundance of secretions requires continuous aspiration.

Since bronchoscopy allows one to judge only the endobronchial manifestations of the inflammatory process, when describing inflammatory changes, the conventional term “endobronchitis” is used to a certain extent. Depending on the bronchoscopic picture, several types of endobronchitis can be distinguished. With catarrhal endobronchitis, signs of inflammation of the mucous membrane are detected in the form of hyperemia, some swelling, friability, increased bleeding in the absence of evidence of its thickening or thinning. Atrophic endobronchitis is characterized by thinning and dryness of the mucous membrane. The cartilaginous pattern is enhanced, the interbronchial spurs are sharpened, the hyperemia is often uneven - in the form of injection of superficial vessels or redness in the area of ​​​​the intercartilaginous spaces, while maintaining a pale pink color over the cartilaginous rings. With hypertrophic endobronchitis, the mucous membrane is thickened, the cartilaginous pattern is smoothed, the interbronchial spurs are expanded, the lumens of the bronchi are not sharply, evenly narrowed. With pronounced changes, the cartilaginous pattern is not differentiated, the narrowing of the lobar bronchi increases and reaches a degree where inspection of the segmental orifices becomes difficult or impossible. The leading symptom of purulent endobronchitis is abundant purulent secretion. Purulent endobronchitis in most cases is the result of a suppurative process in medium-sized bronchi inaccessible to endoscopy (bronchiectasis) or in intrapulmonary cavities (lung abscess). Rarer forms of endobronchitis are fibrous-ulcerative, hemorrhagic and granulating.

Tracheo-bronchial hypotonic dyskinesia

Tracheo-bronchial hypotonic dyskinesia is a violation of the elastic-elastic properties of the walls of the bronchi as a result of dystrophic changes in the supporting elements, accompanied by an increase in their respiratory mobility until complete collapse on exhalation. With a sharp degree of hypotonic dyskinesia, expiratory collapse (collapse) of the walls of the trachea and main bronchi is observed, sometimes detectable even with quiet breathing.

Stenosis of the trachea and bronchi

Stenosis of the trachea and bronchi occurs due to the proliferation of tumor tissue, inflammatory changes, scar deformation, and external compression. Bronchoscopy allows you to determine the location, degree and nature of tracheobronchial stenoses. Conventionally, three degrees of narrowing are distinguished: I - by 1/8 of the lumen, II - by 1/2 of the lumen, III - by more than 2/3 of the lumen. In cases of stenosis due to a bronchial tumor, bronchoscopy reveals the proliferation of tumor tissue, usually coming from one of the bronchial walls (endobronchial form), or an uneven, most often concentric narrowing of the bronchial lumen with infiltration of the mucosa (peribronchial form). With inflammatory narrowing, the lumen of the bronchus retains its regular rounded shape. In cases where stenosis is caused by the formation of granulations, multiple papillomatous growths are visible, sometimes resembling endobronchial tumor growth. With cicatricial stenosis, the lumen of the bronchial tube has an irregular shape; whitish strands are often visible, deforming the bronchial wall. The condition of the mucous membrane can be different - from normal to severe inflammatory changes. Compression stenoses are manifested by bulging or bringing together the walls of the bronchi, their lumen becomes from round to oval or slit-like. As with cicatricial stenoses, the condition of the mucous membrane may vary. To clarify the cause of narrowing of the trachea and bronchi, especially if a tumor is suspected, a biopsy and histological confirmation of the diagnosis are necessary.

Foreign bodies of the bronchi

Foreign bodies of the bronchi are easily detected and removed during bronchoscopy, performed in the first hours after their aspiration, when there are no secondary inflammatory changes in the bronchial tree. If the entry of foreign bodies into the bronchi remains unnoticed, they usually lead to a severe inflammatory process distal to the site of obstruction, often complicated by abscess formation in the pulmonary parenchyma, and lead to the development of bronchiectasis. Foreign bodies of organic origin (bone, tree bark, ear, nut shell and others) remaining in the bronchial tree for a long time, as a rule, cause the proliferation of granulation tissue at the point of contact with the bronchial wall. After removing the foreign body, it is necessary to perform a biopsy from the altered area of ​​the bronchial wall, since in some cases a malignant tumor may develop in this area. Foreign bodies of inorganic origin, even with a long stay, rarely lead to abundant proliferation of granulation tissue; their detection and removal during bronchoscopy is usually simpler.

Broncholithiasis (stone formation)

Broncholithiasis (stone formation) rarely occurs in the lumen of the bronchus. In most cases, lime is deposited in the lymph node adjacent to the bronchus as a result of necrotic inflammation, usually of tuberculous etiology. Penetration of a calculus into the lumen of the bronchus is preceded by bulging of the bronchial wall and the formation of a bedsore. Broncholitis can be located in the lumen of the bronchus (endobronchial stone) or remain partially embedded in the bronchial wall (intramural stone). Bronchoscopic examination for broncholithiasis reveals obstruction of the bronchial tube with a greyish-yellow stone.

Hemoptysis and pulmonary hemorrhage

Bronchoscopy allows you to clarify the source of bleeding and helps in diagnosing the pathological process underlying the complication. Bronchoscopic examination plays a leading role in identifying such causes of hemoptysis as benign and malignant tumors of the tracheobronchial tree, broncholithiasis, bronchial foreign bodies and others. The ability of bronchoscopy to clarify the source of bleeding increases if the study is performed against the background of ongoing hemoptysis. In case of profuse pulmonary hemorrhage, this is associated with a certain risk, and the study should be carried out in conditions that provide the possibility of emergency surgical intervention on the lungs.

When interpreting endoscopic data, it is necessary to take into account that the main lesion is often localized in smaller bronchial branches and lung parenchyma. Clarification of the reasons underlying changes in the bronchial tree requires, in addition to bronchoscopy, the use of radiography, bronchography and other research methods.

Norms

A normal tracheobronchial tree is endoscopically characterized by a clearly defined cartilaginous pattern, pink color of the mucous membrane, and a regular rounded shape of the bronchial lumens. In the area of ​​the membranous part of the trachea and main bronchi, one can often distinguish longitudinal grooves formed as a result of the contouring of muscle bundles. Interbronchial spurs are smooth, with narrow ridges. There is no bronchial secretion. The respiratory mobility of the walls of the trachea and bronchi is relatively small. Their lumen, even with forced breathing and coughing, does not decrease by more than 1/3.

Bronchoscopy is a diagnostic method that allows the doctor to examine the airways. This procedure is performed by inserting a special endoscopic instrument, a bronchoscope, through the nose or mouth and down the throat to reach the lungs. There are many various methods diagnostics of the respiratory system, such as bronchography, chest radiography, CT chest, spirography - all of them are widely used, including bronchoscopy, which, in some cases, is vital.

Bronchoscopy first came into clinical use in 1897, when Killian removed a pig bone from the right main bronchus of a German farmer. Early clinical applications of bronchoscopy were limited to the removal of foreign bodies. As lighting and optical technology, particularly the Hopkins rod and lens system, improved, bronchoscopy became more widely used. Wood and Flink first described the use of a flexible bronchoscope in children in 1978. In 1981, fiberoptic bronchoscopes thin enough for use in children became widely available. Since then, there has been a rapid increase in the use of flexible bronchoscopy, as well as its improvement.

Types of bronchoscopy

Flexible bronchoscopy is done using a long, thin, lighted tube that is designed to look at the airway. A flexible bronchoscope is used more often than a rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and offers best review smaller airways. It also allows the doctor to take small tissue samples (biopsy).

Solid bronchoscopy is usually performed under general anesthesia and a straight metal tube is used during the procedure. It is used when there is bleeding that may block the view of a flexible bronchoscope, or when large tissue samples need to be taken for biopsy, or to remove foreign bodies in the airway that a flexible bronchoscope cannot handle.

Indications for bronchoscopy

Bronchoscopy - most often diagnostic procedure, which is done to diagnose lung diseases, tumors, chronic cough, and infections. Depending on the condition and disease of the patient, during bronchoscopy you can find: blood, mucus, signs of an infectious process, swelling, puffiness, the presence of a foreign body, tumor.

Indications for bronchoscopy:

• to detect the cause of the problem (eg, bleeding, chronic cough, difficulty breathing);
• to take tissue samples when other tests, such as a chest X-ray or CT scan, show problems with the lung or lymph nodes in the chest;
• to diagnose lung disease by collecting samples of tissue or mucus (sputum);
• to determine the degree of lung cancer;
• to remove foreign bodies that block the airways;
• for brachytherapy;
• for the diagnosis of bronchial tuberculosis (bronchoscopy is performed for differential diagnosis with other diseases).

Preparation for the procedure

Before starting the procedure, the patient needs to remove dentures, glasses, contact lenses, hearing aids, if any of the above are available. During bronchoscopy, a local anesthetic spray is used, which is applied to the throat and nasal cavity. The patient may also be given a sedative to help them relax.

A patient scheduled for bronchoscopy should not eat or drink 6-12 hours before the procedure, so it is worth undergoing bronchoscopy in the first half of the day. It is worth consulting your doctor about what medicines you need to stop taking it before the procedure.

Before the procedure you should empty your bladder. You need to remove all or most of your clothing. The procedure is also carried out by an assistant. During the procedure, heart rate, blood pressure and blood saturation levels will be checked. A chest x-ray must be performed before the procedure.

Before performing a bronchoscopy, your doctor may order other tests, such as: general analysis blood, lung function tests.

Algorithm for bronchoscopy

Flexible bronchoscopy algorithm

The patient lies on the table on his back with a pillow under his shoulders and neck or reclining on a special chair. Before the procedure, the doctor usually sprays a local anesthetic into the nose and mouth; anesthesia is not usually used. This reduces the gag reflex during the procedure. If the bronchoscope must be inserted through the nose, the doctor may also place an anesthetic ointment in the nose. The doctor carefully and slowly inserts a thin bronchoscope through the mouth (or nose) and advances it toward the vocal cords. More anesthetic is then sprayed through the bronchoscope to numb the vocal cords. The patient is asked to take a deep breath and it is important not to attempt to speak while the bronchoscope is in the airway. The bronchoscope is then moved down to examine the lower airway. If the procedure is being done to collect sputum or tissue samples for biopsy, a special tiny instrument or brush will be used. If there are indications, the airways are washed with saline and the samples are sent to the laboratory.

Rigid bronchoscopy algorithm

This procedure is performed under general anesthesia. The patient lies on the table on his back, with his neck and shoulders supported by a pillow. The patient is connected to a ventilator. The bronchoscope is then slowly and carefully inserted through the mouth. And then the procedure is carried out in the same way as flexible bronchoscopy.

The doctor will report the results of bronchoscopy immediately; after the procedure, the doctor will give an opinion or after a few days if tissue samples were taken for further research.

What does the patient feel during the procedure?

If general anesthesia was performed, the patient will not feel anything during the procedure. There may be a feeling of pressure in the airways as the bronchoscope is moved from one place to another. During bronchoscopy, the patient may experience. After the procedure, there may be a sensation throughout the day; it may be felt if local anesthesia was used. It is also possible to feel a sore throat, difficulty swallowing after the procedure. If a biopsy was performed during the bronchoscopy, the patient may spit out small blood clots, which is normal.

Contraindications to the procedure

Absolute contraindications include:

• uncontrolled, life-threatening arrhythmias;
• inability to adequately oxygenate the patient during the procedure;
• acute respiratory failure with hypercapnia (if the patient is not intubated and not ventilated);
• tracheal obstruction;

Relative contraindications include:

• non-contact patient;
• recent myocardial infarction;
• uncorrectable coagulopathy.

Transbronchial biopsy should be performed with caution in patients with uremia, superior vena cava obstruction, or pulmonary hypertension because of increased risk bleeding. However, airway examination is safe in these patients.

Extended and Modified Methods

Sometimes advanced forms of visualization may be used as they can provide more comprehensive visualization. The following methods exist:

1. Virtual bronchoscopy. During virtual bronchoscopy, a CT scan is used to see the airways in more detail. This procedure does not use a bronchoscope, meaning it is not endoscopic, but a type of CT scan.
2. Endobronchial ultrasonography. Endobronchial ultrasonography uses an ultrasound probe that is attached to a bronchoscope to view the airway.
3. Fluorescence bronchoscopy. During fluorescence bronchoscopy, a fluorescent light is additionally used, which is attached to the bronchoscope - this allows you to see the inside of the lungs.

New methods of bronchoscopy:

1. Bronchial thermoplasty: This new technique is being developed to gently heat the airways of some patients with asthma. It reduces asthma exacerbations.
2. Emphysema Volume Reduction: Small one-way valves are placed in the airway of the damaged lung, they reduce the volume of that part and leave room for the remainder of the normal lung to function.
3. Repairing air leaks after lung resection: One-way valves are used to slow air leaks at lung suture lines. By slowing the airflow, these leaks can heal faster and prevent the need for further surgery.
4. Sanitation bronchoscopy, which is performed for therapeutic purposes.

Recovery after bronchoscopy

Bronchoscopy is performed relatively quickly, lasting about 30 minutes. Since the patient needs to recover and calm down after the procedure, he will rest in the hospital for another couple of hours until he feels alert and the numbness will go away in the throat. State of respiratory function and arterial pressure should be monitored during recovery.

Immediately after the procedure, you should not eat or drink anything until the numbness in your throat has completely passed, which usually takes one to two hours. The patient will have to spit out saliva until he can swallow it, and it is also contraindicated to drive for 8 hours after the procedure and smoke during the day.

It is also possible that pain and discomfort in the throat may persist for several days, and your voice may become hoarse. All of these symptoms are normal, do not last long and go away on their own without additional treatment.

Complications of the procedure

Bronchoscopy is a safe procedure and rarely causes complications. And the complications that may arise include: bronchospasms, which can worsen breathing; irregular heart rhythms (arrhythmias); infections such as pneumonia (usually these can be treated with antibiotics); constant hoarseness.

If a biopsy was performed during bronchoscopy, complications that may occur include: partial collapse of the lung (pneumothorax), bleeding caused by the biopsy forceps used to collect tissue, infection from the biopsy procedure.

Bronchoscopy in children

In pediatric practice, both rigid and flexible bronchoscopy take place, but flexible bronchoscopy is more widely used.

Bronchoscopy in children is used to diagnose abnormalities in the development of the respiratory system, to examine the nasal cavity, nasopharynx, larynx, trachea, bronchi and esophagus, and to diagnose the presence of a foreign body. Due to the small diameter of the device, flexible bronchoscopy can be used even in newborns.

The procedure in children is performed using anesthetics, sometimes with the use of general anesthesia, and children are often given supplemental oxygen through face masks during the procedure. Effects in children are very rare, but they may include: excessive coughing,

People who know first-hand what serious pathologies of the respiratory tract are have encountered bronchoscopy at least once in their lives and already know what awaits them. But those who are going for such an examination for the first time would really like to know everything about pulmonary bronchoscopy - what it is, how the procedure goes and what to expect after it.

Lung bronchoscopy is a diagnostic method that allows you to visualize the internal state of the trachea and bronchi. Bronchoscopy is an invasive penetrating research method. A tube from a bronchoscopic device is inserted into the airways through the upper part of the windpipe. The further course of the intervention depends on the tasks.

A bronchoscope has a fiber that conducts light and a camera that transmits a clear image to a monitor screen. Thanks to modern equipment, it is possible to obtain results with almost 100% accuracy. This is important for patients with various pulmonary diseases. In addition, bronchoscopy for tuberculosis is of great importance for differential diagnosis.

Types of lung bronchoscopy

Flexible bronchoscopy of the lungs is carried out using thin fiberoptic bronchoscope tubes. They have a small diameter, so they can easily move into the lower sections of the bronchi, while maintaining the integrity of the mucosa. This examination is also suitable for the little ones.

Rigid therapeutic bronchoscopy is performed using rigid surgical bronchoscopes. They do not allow examining the small branches of the windpipe, but such equipment can be widely used for therapeutic purposes:

• combating pulmonary blood loss;
• elimination of stenosis in the lower airways;
• removing large unnatural objects from the windpipe;
• removal of mucus from the lower respiratory tract;
• removal of tumors of various etiologies and scar tissue.

For small children, patients with mental disorders or those who are very panicky, video bronchoscopy is performed while they are sleeping. This means being performed under general anesthesia. In what cases such an operation is prescribed is decided by the pulmonologist, based on the existing medical history and concomitant symptoms.

Indications and contraindications for surgery

Diagnostic bronchoscopy is appropriate in the following cases:

• painful cough of unknown etiology;
• disturbances in the frequency and depth of breathing of unknown origin;
• if there is blood in the sputum;
• frequent inflammation of the bronchi or lungs;
• the assumption that an object is stuck in the windpipe or a tumor is present;
• with sarcoidosis;
• cystic fibrosis;
• emphysema;
• bleeding from the respiratory tract.

Bronchoscopy for tuberculosis can be used as an element of general differential diagnosis, and to determine the exact side of pulmonary hemorrhage provoked by this pathology. A study for cancer (bronchogenic carcinoma) of the lung allows you to monitor the growth of the tumor.

For therapeutic purposes, endoscopic intervention is performed in the following cases:

• foreign body in the respiratory tract;
• coma;
• a set of measures aimed at stopping blood loss;
• tumors that have blocked the lumen of the airways;
• the need to administer drugs directly into the respiratory tract.

Sanitation bronchoscopy begins with removing contents from the lower respiratory tract using suction. After washing, 20 ml of the sanitizing mixture is injected, followed by suction. At the end of the procedure, a mucolytic and/or antibacterial agent is administered.

• allergic reaction to anesthesia;
• persistent hypertension;
• diseases associated with severe heart pathologies;
• recent acute cerebrovascular accident or acute lack of blood supply to the heart muscle;
• chronic violation of maintaining normal blood gas composition;
• aortic aneurysm;
• severe mental illness;
• laryngeal stenosis.

When it is necessary and whether it is possible for a particular patient to perform bronchoscopy, the attending physician decides. If therapeutic and diagnostic bronchoscopy is performed with emergency conditions, then some contraindications may not be taken into account.

Preparing for surgery

Bronchoscopy of the lungs requires careful preparation. The doctor should explain to the patient how to best prepare. First of all, the patient is prescribed a series of examinations, and the bronchoscopy procedure can be performed when the tests are ready.

Minimum required:

• general clinical blood test;
• complex analysis of blood clotting indicators;
• examination of arterial blood for gas composition;
• electrocardiogram;
• chest x-ray.

If the bronchoscopy technique requires the use of premedication before the procedure, then the patient must be checked for allergies to certain drugs.

You can eat your last meal 8-12 hours before the scheduled procedure. Moreover, for dinner you should not eat poorly digestible food, as well as food that causes flatulence. The night before, you should cleanse the intestines using a classic enema or a pharmacy microenema. On the day of the study you should stop smoking. You should enter the diagnostic room with an empty bladder.

How is bronchoscopy performed?

Therapeutic or diagnostic bronchoscopy should be performed in a specially equipped room under sterile conditions.
Examination of the mucous membrane of the respiratory tract under local anesthesia is performed according to the following algorithm:

1. The patient is given an injection of Atropine in the shoulder area. This active substance suppresses salivation.
2. A bronchodilator drug from the group of selective β₂-adrenergic receptor agonists is sprayed into the oral cavity.
3. An anesthetic is applied to the back third of the tongue, facing the pharynx, or slightly lower by spraying and splashing. The same agent is applied to the outer part of the bronchoscope.
4. The bronchoscope tube is delicately inserted into the oral cavity and then advanced. The tube is usually inserted after a mouthpiece is inserted into the patient’s mouth, which is necessary to ensure that the patient does not damage the bronchoscope with his teeth.
5. If the patient lies down during the procedure, a laryngoscope can be inserted into his oral cavity and larynx, which facilitates the insertion of a bronchoscope.

The diagnostician performs the necessary manipulation quickly enough and the entire diagnostic procedure does not last long, so as not to cause severe hypoxia. If therapeutic manipulations are performed, the duration increases. Thus, bronchoscopy for pneumonia can last 30 minutes.

Bronchoscopy with biopsy is considered a fairly painless procedure. The biopsy sample is taken with special forceps. Since the mucous membrane of the branches of the windpipe is practically devoid of pain receptors, during the manipulation the patient experiences only mild discomfort behind the sternum. If the method is used under anesthesia, then after an intravenous injection the person falls asleep and does not feel anything during the procedure.

Is anesthesia used?

Many endoscopists believe that in some pathologies it is better not to suppress the natural reflex activity of the airways. They only numb the root of the tongue, the cartilage above the entrance to the larynx and the inner surface of the upper part of the windpipe. In adult practice, flexible bronchoscopy uses local anesthesia.

Bronchoscopy under anesthesia is predominantly performed using a rigid bronchoscope. Carrying out sleep research is more often used in pediatric practice. Under the influence of anesthetic substances, protective reflex spasms are eliminated, the lumen of the branches of the windpipe expands, which allows endoscopic examination to be carried out in the best possible way.

Features of the procedure in children

In pediatrics, research is allowed from the very early age, but provided that there is a flexible fiberoptic bronchoscope of small diameter.

Pediatrics has its own peculiarities in endoscopic examination of the lower respiratory tract:

• it is necessary to put the baby into medicated sleep;
• bronchoscopy is carried out using a special pediatric bronchoscope;
• During diagnosis, children have an increased risk of developing bronchospasm, so the office must be equipped with everything necessary for performing mechanical ventilation;
• After bronchoscopy, antibacterial agents are mandatory.

The duration of bronchoscopy depends on the tasks. On average, such manipulation takes from a quarter of an hour to half an hour.

Features of manipulation in tuberculosis

If tuberculosis is diagnosed, then bronchoscopy plays an important role in the management of such patients. How long each such procedure lasts depends on the objectives being pursued, and they can be as follows:

• determine the sensitivity of mycobacteria to selected anti-tuberculosis drugs;
• drain the cavity in case of cavernous tuberculosis;
• locally administer anti-tuberculosis drugs;
• dissect the fibrous tissue in the branches of the windpipe;
• stop the bleeding;
• examine the condition of the suture material after lung resection;
• evaluate the condition of the branches of the windpipe, which is caused by this lung disease, before surgery.

Bronchoscopy for tuberculosis turns out to be indispensable in assessing improvements from the chosen treatment tactics.

How is research carried out for bronchial asthma?

Carrying out bronchoscopy for bronchial asthma causes controversy among specialists, since the visualized changes in the mucous membrane in this pathology are nonspecific. They can easily be confused with other diseases of the lower respiratory tract with reversible and irreversible processes.

If moderate or severe asthma worsens, then at any age, it is optimal to use a rigid injection bronchoscope and anesthesia with muscle relaxants against the background of continuous mechanical ventilation. Therapeutic tactics and tools used during the procedure depend on the stage of the pathological process and how severe the respiratory failure is.

What can a lung bronchoscopy reveal?

During an endoscopic examination, it is possible to thoroughly examine the mucous membrane and identify signs of various pathologies:

• neoplasms of various nature;
• pathologies associated with inflammatory processes;
• decreased tone of large bronchi;
• stenosis of the branches of the windpipe;
• frequent attacks of suffocation due to bronchial asthma.

If pathologies requiring urgent intervention have been diagnosed, then during bronchoscopy a therapeutic effect will be immediately provided. Usually the results of bronchoscopy are known on the same day. But if bronchoscopy with biopsy was performed, then it was necessary to send material for histological examination, so you will have to wait a few days for a response.

Rehabilitation after the study

Regardless of whether the manipulation was related to treatment or diagnosis, after the procedure doctors recommend adhering to the following rules:

• After the procedure, you should not rush home, but it is better to remain under the supervision of a specialist for some time (2-4 hours);
• You can drink and eat only 2-3 hours after the manipulation;
• After the procedure, it is better not to smoke in the next 24 hours, as this impairs the restoration of the mucous membrane;
• if sedation was performed, then it is better to refrain from driving vehicles for the next 8 hours;
• Avoid physical fatigue for 2-3 days.

In addition, it is important to monitor your well-being. If chest pain, fever, or coughing up blood occurs, you should immediately go to the hospital.

Possible complications

Bronchoscopy most often passes without consequences, but it is also possible possible harm health of the patient. Complications usually occur if the procedure is performed by an inexperienced endoscopist.

Possible consequences and complications:

• an acute condition that occurs when the muscles of the bronchi contract and their lumen narrows;
• sudden involuntary contraction of the muscles of the larynx;
• accumulation of air or gases in the pleural cavity;
• bleeding after biopsy;
• pneumonia caused by infection of bronchioles;
• violation of the frequency, rhythm and sequence of excitation and contraction of the heart;
• increased individual sensitivity.

If bronchoscopy has diagnostic purposes, then CT or MRI can be used as an alternative. But there is nothing to replace a medical manipulation of this kind. To avoid serious consequences, you can only agree to such a procedure in a trusted medical institution.