Transbronchial needle aspiration (TBNA) has proved its efficacy, safety, and cost-effectiveness in diagnosing and staging bronchogenic carcinoma as well as in diagnosing benign diseases such as sarcoidosis and tuberculosis. However, it is not used as frequently as expected in routine bronchoscopy practice. In an effort to show its use in the Asian-Pacific countries, published TBNA-related articles from these countries have been searched and reviewed. Most of the articles are from Japan, China, Turkey, and India. However, as is seen from the limited number of articles, even in these countries, TBNA is not used extensively. Factors leading to underuse of TBNA include lack of training, suboptimal technique, faulty site selection, incomplete penetration of needle, kinking of the transbronchial catheter, a confusing array of needles, failure to reproduce high diagnostic yields, concerns about the safety of TBNA, inadequate cytopathology support, fear of bronchoscopic damage, and reservations regarding usefulness of this method. There remains no doubt that training with the TBNA technique and experience will improve TBNA results. Collaboration between thoracic surgeons, pulmonologists, oncologists, and pathologists will also help to establish a sound TBNA program in institutions. Only in this way can TBNA be optimized as a nonsurgical, cost-effective, and safe procedure.