INTRODUCTION

The ability of the bronchoscope to provide either diagnostic data or a therapeutic intervention is changing with technology. Improvements in digital imaging and materials along with newer interfaces utilizing positioning technology and diagnostic imaging are enhancing the capabilities of flexible bronchoscopy. Thus the role of flexible bronchoscopy in practice is changing and will depend on the facilities available at a particular center. This review will go over the broad indications and the relatively few contraindications for flexible bronchoscopy based on the current state of the art. The considerations important for obtaining informed consent as it pertains to flexible bronchoscopy will also be reviewed.

INDICATIONS FOR FLEXIBLE BRONCHOSCOPY

Indications for flexible bronchoscopy are often thought of in terms of diagnosis and therapy. For diagnostic bronchoscopy, we can divide areas broadly into endobronchial signs and symptoms, findings from diagnostic studies such as chest radiography, and those based on specific injuries that may impact the airways. Symptoms and signs of endobronchial disease are the most common indications for flexible bronchoscopy and include chronic cough, hemoptysis, focal unexplained atelectasis, or a postobstructive pneumonia. Findings on examination can also be indications for flexible bronchoscopy including a localized wheeze, which could be the result of something partially blocking an airway. Patients with what sounds like refractory “asthma” or focal findings of wheezing on examination, or altered breath sounds associated with a radiographic finding may be appropriate indications (Figure 8.1).