# Bronchoscopic management of airway foreign bodies in adults: a narrative educational review

## TL;DR

This review provides a step-by-step guide for bronchoscopic removal of foreign bodies in adult airways, emphasizing imaging, tool selection, and procedural techniques to improve safety and success rates.

## Contribution

Proposes a practical, stepwise algorithm for bronchoscopic management of adult airway foreign bodies, integrating clinical evidence and procedural nuances.

## Key findings

- Flexible bronchoscopy under anesthesia achieves >90% success for peripheral AFBs, while rigid bronchoscopy is preferred for large or proximal objects.
- CT has high sensitivity and specificity for AFB detection but may miss radiolucent materials, necessitating bronchoscopy in high-suspicion cases.
- Object-specific retrieval tools (e.g., forceps, snare, basket) improve success rates, and hybrid rigid-flexible approaches enhance safety.

## Abstract

Airway foreign body (AFB) in adults remains a potentially life-threatening emergency, which lacks standardized clinical pathways of management. This review aims to synthesize current evidence on the clinical recognition, imaging work-up, and bronchoscopic management of AFB in adults and to propose a practical, stepwise algorithm, enabling interventional pulmonologists to establish a systematic retrieval framework as early as possible and thereby optimize care for adult patients.

A narrative review was conducted by searching PubMed for studies focusing on the bronchoscopic management of AFB in adults. The emphasis is on the tool selection, critical techniques, and procedural nuances for AFB retrieval. Personal clinical experience also informed the interpretation and contextualization.

Adult AFB typically presents with chronic cough, dyspnea, wheeze, or recurrent post-obstructive pneumonia. Computed tomography (CT) is the first-line imaging modality (pooled sensitivity 98.8%, specificity 96.6%), but radiolucent organic material may yield false-negative results; therefore, high clinical suspicion warrants direct bronchoscopy. The right main bronchus is the most common site because of its anatomical features. Pre-intervention planning matches AFB characteristics (site, size & shape, and substance) with patient status to decide between rigid and flexible scopes and to select retrieval accessories. Flexible bronchoscopy under general anesthesia via laryngeal mask airway achieves > 90% success in adults, which is preferred for peripheral items, whereas rigid bronchoscopy remains the gold standard for large, sharp, or proximal AFBs. Tool choice follows an object-specific strategy: forceps for metal/bone, snare for bulky, irregular items, basket for smooth, round seeds, balloon for impacted distal AFBs after dilation, and cryoprobe for semisolid, water-rich material (blood clot, mucus plug, food). Complication rates are lowest when dislodgement and extraction are performed as a single, controlled maneuver under continuous visualization; hybrid rigid–flexible approaches further improve safety.

Consider AFB in adults with unexplained chronic respiratory symptoms. CT guides but does not replace bronchoscopy. An individualized strategy—flexible scope first (in patients with stable status), rigid scope reserved for selected complex cases—combined with object-tailored tools optimizes successful AFB retrieval while minimizing morbidity. Maintaining both rigid and flexible systems, trained multidisciplinary teams, and strict manometric monitoring are essential components of AFB retrieval.