BACKGROUND: There is sparse evidence in the literature in relation to indications and outcomes among adult Indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between Indigenous and non-Indigenous patients were assessed. METHODS: Self-reported Indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between Indigenous and non-Indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes. RESULTS: Of the 403 patients, 111 (28%) were Indigenous and Indigenous patients were younger (mean difference 11 years) and higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, though Indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, Indigenous patients had higher presence of S. Pneumoniae (30% vs 9%), while non-Indigenous patients had higher presence of P. Aeruginosa (43% vs 11%) and of mycobacteria (15% vs 4%). There were no significant difference between Indigenous and non-Indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%). CONCLUSIONS: This study has demonstrated that adult Indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and to demonstrate differing microbiology with no significant difference in the outcomes for lung malignancy. Ethnic status or remoteness should not preclude Indigenous patients to undergo a FB if clinically indicated. This article is protected by copyright. All rights reserved.