Bronchoscopy Basics: Current approaches-A literature review

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Naved Hasan


Objective: This review article aims to understand the basic airway anatomy, bronchoscopy in high risk patients, premedication in bronchoscopy and performing the procedure in patients on anticoagulation. Basic bronchoscopy is the procedure done by pulmonologists, intensivists, thoracic surgery, and anesthesiologists. After a literature search from several databases, including PubMed, Google Scholar, Medline, Science Direct, Cochrane Library, Update etc., I found several categories of high-risk patients based on clinical history, Mallampati score, and 3-3-2 Rule. These include patients with pulmonary hypertension, renal failure, COPD, asthma, obesity, patients on anticoagulation. I searched the literature to find multiple expert guidelines and recommendations that suggested minimizing the risk of complications in these high-risk patients, including premedication.


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How to Cite
Hasan, N. (2022). Bronchoscopy Basics: Current approaches-A literature review. Medical Science and Discovery, 9(2), 76–79.
Review Article
Received 2022-02-14
Accepted 2022-02-20
Published 2022-02-23


Wahidi MM, Rocha AT, Hollingsworth JW, Govert JA, Feller-Kopman D, Ernst A. Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature. Respiration. 2005 May-Jun;72(3):285-95. doi: 10.1159/000085370. PMID: 15942298. DOI:

Diaz-Fuentes G, Bajantri B, Adrish M: Safety of Bronchoscopy in Patients with Echocardiographic Evidence of Pulmonary Hypertension. Respiration 2016;92:182-187. doi: 10.1159/000448848 DOI:

Lashari BH, Asai M, Alswealmeen W, Hodge C, Ripley-Hager C, Patel RK. Pulmonary Hypertension and Transbronchial Lung Biopsy: Does It Increase the Risk of Hemorrhage? Cureus. 2020 Jul 9;12(7):e9084. doi: 10.7759/cureus.9084. PMID: 32789034; PMCID: PMC7417037. DOI:

Diaz-Guzman E, Vadi S, Minai OA, Gildea TR, Mehta AC. Safety of diagnostic bronchoscopy in patients with pulmonary hypertension. Respiration. 2009;77(3):292-7. doi: 10.1159/000197465. Epub 2009 Jan 28. PMID: 19174601. DOI:

Melissa H. Turkey, Renda Soylemez Wiener. Population-based estimates of transbronchial lung biopsy utilization and complications. Respir Med. 2012 Nov; 106(11): 1559-1565. DOI: DOI:

Bellinger, Christina R. MD*; Khan, Irtaza MD†; Chatterjee, Bronchoscopy Safety in Patients With Chronic Obstructive Lung Disease, Journal of Bronchology & Interventional Pulmonology: April 2017 - Volume 24 - Issue 2 - p 98-103. doi: 10.1097/LBR.0000000000000333 DOI:

Stolz D, Pollak V, Chhajed PN, Gysin C, Pflimlin E, Tamm M. A randomized, placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD. Chest. 2007 Mar;131(3):765-772. doi: 10.1378/chest.06-2308. PMID: 17356091. DOI:

Moore WC, Evans MD, Bleecker ER, et al. Safety of investigative bronchoscopy in the Severe Asthma Research Program. J Allergy Clin Immunol. 2011;128(2):328-336.e3. doi:10.1016/j.jaci.2011.02.042 DOI:

Van Vyve T, Chanez P, Bousquet J, Lacoste JY, Michel FB, Godard P. Safety of bronchoalveolar lavage and bronchial biopsies in patients with asthma of variable severity. Am Rev Respir Dis. 1992 Jul;146(1):116-21. doi: 10.1164/ajrccm/146.1.116. PMID: 1626794. DOI:

Djukanović R, Wilson JW, Lai CK, Holgate ST, Howarth PH. The safety aspects of fiberoptic bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy in asthma. Am Rev Respir Dis. 1991 Apr;143(4 Pt 1):772-7. doi: 10.1164/ajrccm/143.4_Pt_1.772. PMID: 2008989. DOI:

Khan I, Chatterjee AB, Bellinger CR, Haponik E. Sedation for Bronchoscopy and Complications in Obese Patients. Respiration. 2016;92(3):158-65. doi: 10.1159/000448250. Epub 2016 Sep 6. PMID: 27595264. DOI:

Malik JA, Gupta D, Agarwal AN, Jindal SK. Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate. Chest. 2009 Aug;136(2):347-354. doi: 10.1378/chest.08-2924. Epub 2009 Mar 24. PMID: 19318667. DOI:

Webb AR, Woodhead MA, Dalton HR, Grigg JA, Millard FJ. Topical nasal anesthesia for fibreoptic bronchoscopy: patients' preference for lignocaine gel. Thorax. 1989;44(8):674-675. doi:10.1136/thx.44.8.674 DOI:

Antoniades N, Worsnop C. Topical lidocaine through the bronchoscope reduces cough rate during bronchoscopy. Respirology. 2009 Aug;14(6):873-6. doi: 10.1111/j.1440-1843.2009.01587.x. PMID: 19703068. DOI:

Wahidi MM, Jain P, Jantz M, Lee P, Mackensen GB, Barbour SY, Lamb C, Silvestri GA. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011 Nov;140(5):1342-1350. doi: 10.1378/chest.10-3361. PMID: 22045879. DOI:

Ernst A, Eberhardt R, Wahidi M, Becker HD, Herth FJ. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest. 2006 Mar;129(3):734-7. doi: 10.1378/chest.129.3.734. PMID: 16537875. DOI:

Du Rand IA, Blaikley J, Booton R, et al British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE Thorax 2013;68:i1-i44. DOI:

Lange CM, Fichtlscherer S, Miesbach W, Zeuzem S, Albert J. The Periprocedural Management of Anticoagulation and Platelet Aggregation Inhibitors in Endoscopic Interventions. Dtsch Arztebl Int. 2016;113(8):129-135. doi:10.3238/arztebl.2016.0129 DOI: