From our experience of extraction of TBFBs over more than a decade, we have drawn the following conclusions: (1) TBFBs present most frequently in the age group of 1 to 2 years, with cough and/or breathlessness commonly following a choking episode; (2) a high index of suspicion is essential and diagnostic FB should be performed in all such cases even though the chest radiograph is normal; (3) TBFBs can be life threatening and may require to be treated as an emergency; (4) FB may be used first for diagnosis and extraction under conscious sedation for nonasphyxiating TBFBs. It is usually more successful in adults and less so in children; (5) in these patients, if FB is unsuccessful, then RB may be used to extract the TBFB; (6) for asphyxiating TBFBs, RB is the procedure of choice; (7) pulmonologists who wish to practice extraction of TBFBs ought to be trained in both FB and RB and must possess adequate equipment and a skilled team to assist them.

The insertion of a metallic Y stent results in immediate palliation of malignant airway obstruction or airway fistulization near the tracheal carina with rapid improvement of symptoms.

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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