OBJECTIVES: To investigate the role of both diagnostic and interventional paediatric bronchoscopy in the management of respiratory diseases in children in low- and middle-income countries (LMICs). DESIGN: A review of published English literature from January 2014 to February 2024. RESULTS: Indications for bronchoscopy in LMICs will vary depending on the burden of infectious diseases like tuberculosis (TB) and HIV, and the expertise and equipment available. TB diagnosis in children remains challenging due to the paucibacillary nature of the disease and its overlap with other infectious diseases like actinomycosis and echinococcosis. Acquired conditions, such as foreign body (FB) inhalation, present late with a high complication rate, making them challenging to manage. Paediatric bronchoscopy has an important role in the diagnoses, management and follow-up of many of these conditions. Interventional procedures like endobronchial ultrasound (EBUS), radial EBUS and cryotherapy enhance diagnostic and management capabilities. CONCLUSION: Children in LMICs are affected by both infectious and acquired conditions. Bronchoscopy remains expensive with limited training offered in LMICs but is increasingly recognised for its important diagnostic and therapeutic role.