Synopsis
Choose and handle respiratory samples intelligently, understand what bronchoscopy can answer, and translate laboratory results into safe clinical decisions without mistaking detection for disease.
- Begin with a clinical question: routine bacterial culture, tuberculosis or non-tuberculous mycobacteria, fungal disease, viral infection, cytology, diffuse lung disease or an endobronchial lesion require different samples and laboratory handling.
- Collect sputum before antimicrobials when this is safe, but never delay treatment of severe infection merely to obtain a perfect sample.
- A good lower-respiratory specimen is freshly expectorated after mouth rinsing into the correct sterile container; saliva and delayed transport reduce interpretability.
Key red flags
Severe pneumonia, treatment failure, immunosuppression, unusual exposure, cavitation or recurrent infection makes microbiological definition more valuable. Ask what organism class matters and collect the least invasive high-quality sample that can answer it.
Investigation priorities
Identify plausible bacterial pathogens and guide narrower treatment.
Management branches
A lower respiratory infection question where microbiology could change management.
- Define the syndrome and request: routine bacterial culture, mycobacteria, fungi, viral testing or cytology need distinct instructions and sometimes different containers.
- Before antimicrobials when clinically safe, ask the patient to rinse the mouth, take deep breaths and expectorate lower-airway sputum directly into a labelled sterile pot.
Key medicines
Topical lidocaine for flexible bronchoscopyUse the lowest effective topical dose by the locally approved bronchoscopy protocol, recording cumulative administration throughout the procedure.
Titrated intravenous midazolam procedural sedationGive incremental intravenous doses only by trained staff under the current local sedation protocol, using less in frailty or respiratory vulnerability.