The role of flexible bronchoscopy

Flexible bronchoscopy is an integral part of tertiary paediatric respiratory practice. It has a mainly diagnostic role, from direct observation (anatomy and structure, airway contents, dynamics), and sampling (lavage, biopsy and brushings). There are also some therapeutic roles, mainly re-inflation of an atelectatic segment or lobe. Clinical situations that may require referral for consideration of a bronchoscopy include chronic or recurrent stridor, severe wheeze, chronic cough, recurrent pneumonia, and pneumonia that fails to resolve. Additionally, bronchoscopy is often required in children with chronic suppurative lung disease, patients ventilated in a paediatric or cardiac intensive care unit, and children who have undergone transplantation. Finally its use in research is increasingly improving our understanding of the pathophysiology of asthma and cystic fibrosis.