What are the key indications for referring a patient for bronchoscopy in primary care?

Key indications for referring a patient for bronchoscopy in primary care include:

• Persistent or recurrent chest infections in patients aged 40 and over, especially when lung cancer is suspected, warrant urgent chest X-ray and may lead to bronchoscopy referral if abnormalities are found ¹.
• Unexplained haemoptysis (coughing up blood) requires exclusion of bronchial carcinoma and is an indication for specialist referral, often involving bronchoscopy ².
• Abnormal chest X-ray findings suggestive of lung cancer or other lung pathology such as masses, persistent infiltrates, or suspicious lesions should prompt referral for bronchoscopy to obtain tissue diagnosis ¹,².
• Symptoms suggestive of lung cancer or mesothelioma (e.g., unexplained cough, chest pain, weight loss, hoarseness, finger clubbing, or chest signs consistent with lung cancer) in patients aged 40 and over, especially with relevant risk factors (smoking, asbestos exposure), require urgent chest X-ray and may lead to bronchoscopy referral if imaging is suspicious ¹.
• Diagnostic uncertainty in chronic respiratory diseases such as COPD with atypical features, or suspicion of other diagnoses like bronchiectasis or malignancy, may necessitate bronchoscopy after initial investigations ².

In summary, bronchoscopy referral from primary care is primarily indicated when there is suspicion of lung cancer or other serious lung pathology based on symptoms, signs, or imaging findings, or when haemoptysis is present and malignancy must be excluded ¹,².