Study objective: To retrospectively review the indications and complications associated with flexible fiberoptic bronchoscopy (FFB) in a university teaching hospital. Design: retrospective review from April 1, 1988 to March 30, 1993. Setting: Large tertiary care university hospital. Patients or participants: We reviewed 4,273 consecutive FFBs, including 2,493 bronchoalveolar lavages and 173 transbronchial biopsy procedures. Interventions: None. Results: Most (52%) FFBs were performed for obtaining lower respiratory tract samples for evaluation of suspected infection, tin additional 17%, were performed to evaluate an abnormality seen on chest radiograph. The most common therapeutic indication was removal of retained secretions in 8% of FFBs. The mortality rate was 0%, and the frequency of major and minor complications was 0.5% and 0.8%, respectively. The incidence of major complications secondary to transbronchial biopsy was 6.8%. Conclusions: Flexible fiberoptic bronchoscopy can be performed safely in a teaching hospital with appropriate preparation, supervision, and adherence to protocol.