Preparing of the patient, performing diagnostic flexible bronchoscopy and sampling from the airways.

The preparation of the patient is a crucial time as it can contribute to the success of the bronchoscopic examination. First and foremost, preparation provides the patient with correct information regarding the procedure by which bronchoscopy is performed and informs him/her of sensations that may be felt. The anxiety and worry manifested by the majority of patients undergoing bronchoscopic examination can in a large part be alleviated by the behaviour of the operators, who must reassure the patient and put them at ease [1] (Level of evidence: III). Bronchoscopy is carried out with the patient fasting, in order to reduce the volume and acidity of the stomach contents, thus avoiding the risk of possible regurgitation and aspiration of gastric material. A minimum of eight hours’ fasting before the bronchoscopy is carried out is recommended [2] (Level of evidence: IV). The Guidelines of the British Society recommend four hours’ fasting [3]. It does not in fact appear that a relatively long fasting time is associated with a lower risk of regurgitation. A meta-analysis [4] of 38 randomised controlled studies on different protocols for pre-operative preparation and post-operative complications found that there is no evidence that a reduction in fasting times, with liquids being taken, is associated with a greater risk of aspiration-regurgitation (Level of evidence: Ia). Drugs for chronic disorders (e.g. anti-hypertensive drugs, digitalis) can therefore be taken normally, with a very small quantity of water.