Flexible bronchoscopy is a procedure used to examine the lower airways including the trachea and bronchi. The respiratory system consists of the upper airways including the nose, mouth, and larynx, and the lower airways including the trachea, bronchi, and lungs. Flexible bronchoscopy allows doctors to directly visualize the trachea and bronchi down to the level of the terminal bronchioles. The British Thoracic Society published guidelines in 2013 outlining best practices for performing diagnostic flexible bronchoscopy in adults.

1. BTS GUIDELINES 2013 FOR
DIAGNOSTIC FLEXIBLE
BRONCHOSCOPY IN ADULTS
JOURNAL CLUB
Dr. FIROZ A HAKKIM
Dept of CHEST MEDICINE

2. Lower airways
Upper airways
Respiratory System
The respiratory system
consists of the airways,
the lungs, and the
respiratory muscles that
mediate the movement of
air into and out of the
body.
Nasopharynx
Mouth
Trachea

3. Rhinopharynx
Oropharynx
Laryngopharynx
Vocal
cords
Trachea
Esophagus
Pharynx
Epiglottis
Larynx
Upper airway: Pharynx & Larynx
Root of
tongue

4. Liver
Stomach
Rib cage
Heart
Lung
L/R Main bronchus
Lower airway
Trachea

5. Trachea
Main Bronchus
Right Lung
Left Lung
Bronchus
Lower airway: Trachea, bronchi and lung:
Left Superior lobe
Left Inferior lobe
Right Superior lobe
Right Inferior lobe
Middle lobe
C-shaped
cartilage
(Length: 10-12 cm,
Diameter: ~2cm)

6. Bronchial Nomenclature:
Left main
bronchus
Left Supperior
lobar Bronchus
Left Inferior
lobar bronchus
Middle lobar
bronchus
Trachea
Right main
bronchus
Right Superior
lobar bronchus
Right Inferior
lobar bronchus
B1
B3
B2

7. Carina
Primary bronchi (Main bronchi)
each lung
Secondary bronchi (Lobar bronchi)
each lobe
Tertiary bronchi (Segmental bronchi)
bronchopulmonary segment
Subsegmental bronchi (4th level)
5th level…..8th-12th level
Terminal bronchioles
Respiratory bronchiole
Alveoli
B1
B1a
B1ai
B1aiα
B1b..
B1aii..
B1aiβ..

8. PRINCIPLE

21. GUIDELINE - RECOMMENDATIONS

22. FLEXIBLE BRONCHOSCOPY