In recent years, the author found that some of the middle-aged and elderly patients with recurrent tuberculosis hospitalized in our hospital were found to have bronchial scar stenosis or even atresia during tracheoscopy, suggesting that these patients had bronchial tuberculosis when they first developed it several years ago, only that the best time for treatment was lost because it was not detected in time at that time. Although the tuberculosis was controlled with subsequent drug treatment, the bronchi had already undergone irreversible damage. EBTB starts slowly, and studies have shown that approximately 10% to 40% of active TB is associated with EBTB, while 4.1% of routine tracheoscopies are for EBTB, and the incidence is generally thought to be two to three times higher in women than in men. The most common route of infection in adults with EBTB is direct implantation of Mycobacterium tuberculosis into the bronchial mucosa from intrapulmonary lesions, followed by invasion of the bronchial mucosa from intrapulmonary lesions through peribronchial tissues; Mycobacterium tuberculosis can also first invade the submucosa of the bronchus via hematogenous dissemination and lymphatic drainage, and then involve the mucosal layer. There are three main reasons why bronchial tuberculosis is easily misdiagnosed: 1. The symptoms are diverse and lack specificity: cough, sputum, fever, night sweats, hemoptysis, chest pain, wheezing, hoarseness, weight loss, and no clinical symptoms account for 2.6% to 24%. Patients with mild cases think that it is a common cold and often do not seek medical attention in time, or even if they do, it is not easy to attract the attention of clinicians, and when tracheobronchial stenosis, shortness of breath and croup occur, they are treated as common bronchial asthma. 2. Bronchial tuberculosis lesions can be distributed in the left and right main bronchi, right middle lobe, left upper lobe, right upper lobe, left lower lobe, left lingual lobe, right lower lobe, trachea, rhomboid, etc., almost in all lobes of the bronchi, which means that it has the characteristics of dispersion and multiple occurrence. From the imaging point of view, because tracheal and bronchial tuberculosis are scattered and multiple, in the early stage when tracheal occlusion or stenosis is not formed, lung imaging, especially chest X-ray, may be abnormal or may show small patches or dot-like shadows, which may be easily misdiagnosed as tracheal and bronchial inflammation or other pulmonary infectious diseases. A small number of patients have clinical manifestations of irritating dry cough and hemoptysis or blood in sputum, and imaging manifestations of pulmonary atelectasis, lung mass shadow, and enlarged mediastinal lymph nodes in the hilum, which may be misdiagnosed as lung cancer. 3. Tracheoscopic EBTB has distinctive features, so tracheoscopy has a decisive role in confirming the diagnosis of EBTB. The common manifestations are congestion and edema, vesicular ulceration, granulomatous proliferation, and scar stenosis, with the granulomatous proliferation type being the most common among all types of lesions. However, congestion and edema, erosion and ulceration, and granulomatous proliferation are usually seen simultaneously. If visual observation cannot make a predictive diagnosis. The biopsied tissue can be sent for pathological examination, and the typical changes are mainly caseous and non-caseous granulomas with epithelioid and lymphocytic infiltration, and most of them can give a definite diagnosis. However, some patients refuse to undergo bronchoscopy because they are worried that the symptoms such as suffocation and nausea will be unbearable, which leads to delay in the diagnosis and treatment of bronchial tuberculosis. In view of the above reasons: 1. Patients are advised to consult a doctor promptly when they have similar symptoms as mentioned above, especially if they do not improve after a week of cold treatment. 2. Clinicians should accumulate experience and raise awareness of bronchial tuberculosis to achieve early detection and treatment. 3, hospitals with conditions, patients suspected of bronchial tuberculosis can actively carry out chest CT, bronchoscopy. 4. Tracheoscopy is an important method for diagnosing the disease at present, and it is worth promoting its application, so we ask patients to understand, support and cooperate. We hope that through our efforts, we can reduce the damage of tuberculosis to trachea and bronchus to the minimum. It will bring good news to all patients.