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A look into the lungs

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DR. R. NARASIMHAN

Bronchoscopy is an excellent tool to diagnose lung diseases.

BRONCHOSCOPY is the art of looking into the lungs. With the discovery of flexible bronchoscopy, the doors of the lungs were open. A lung biopsy under local anaesthesia was unthinkable and the unimaginable is possible now with flexible bronchoscopy.

History

The first person to visualise the larynx was Signor Manuel Garcia, a music teacher in London who used mirrors to visualise his voice box and upper trachea. Later Horace Green of New York, "Father of the laryngology", passed the tube through the mouth up to the larynx. In March 1897, Gustaf Killian removed a piece of bone from the bronchus of a 63-year-old patient. He is known as the "Father of Bronchoscopy." The credit for fabricating endoscopies in humans goes to Dr. Chevalier Jackson. With his son, he started the concept of endoscopy clinics. The present technique of fibreoptic bronchoscopy was the work of Dr. Ikeda from Japan.Flexible fibreoptic bronchoscopy was not a popular investigative tool in the early 1980s. Patients feared that putting a tube in the lungs was almost secondary to the end of life. The general belief was that bronchoscopy was done only in life-threatening conditions. With physicians, it was non-familiarity with the procedure. For many physicians in the early 1970s, respiratory diseases meant only TB and asthma and both could be diagnosed easily by clinical examination and radiology. Other diagnoses were not even considered.

Increasing interest

With the availability of the flexible bronchoscope, which can reach the sub segmental levels of the lung, there is an increasing interest in this field and in this investigating tool. Many updates and conferences are conducted to make physicians and people aware. Flexible bronchoscope is a diagnostic tool in which a tube with tiny camera in the end is inserted into the nose or mouth.The indications for bronchoscopy can broadly be divided into two categories - diagnostic and therapeutic. Some of the indications are: Persistent cough not responding to treatment and where asthma is reasonably excluded; Episodes of blood stained sputum, especially in a chronic smoker; a change in the nature of cough in a smoker or asthmatic; persistent pneumonia not responding to antibiotics or to anti-TB drugs; a patient of TB not responding to or deteriorating or where there is a suspicion of Multi Drug Resistant TB; in children to remove a foreign body

Simple procedure

The procedure is very simple. The patient should not eat anything for at least four hours earlier. In the bronchoscopy suite and before the procedure is done, the patient will be informed in detail about what will be done. On the day of procedure, an anaesthetic injection is given in the throat. A local spray is given wherever necessary. Depending on the level of anxiety and reaction, sedation is given. The procedure lasts for 10 minutes. During this period a bronchial wash or Bronchoalveolar lavage, a more reprensentative sample from the lungs, can be taken. Where necessary an endobronchial biopsy or lung biopsy can be taken. In a majority of patients no side effects occur. The patients are discharged on the same day.TB can be picked up with ease in more than 90 per cent of cases. If a growth is seen in the bronchus the diagnostic yield is to the extent of 80 to 90 per cent. The wash, being a more representative sample, can be utilised to culture TB or fungus or any other organism. In short, bronchoscopy is an excellent tool in expert hands to diagnose perplexing lung diseases. It can be done as an office procedure. It has no major side effects and if they occur can be handled with ease. A word of caution about this procedure is that there should be a good back up facility should any problems occur to the patient. After all it is the lungs you are looking into!E-mail the writer at drrnarasimhan@gmail.comBroncocon 2006 , the 11th National Conference of Bronchology, organised by the Indian Association of Bronchology was held in Chennai from January 20 to 22.,


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