Respiration in Medical Assessment

Respiration refers to the process of breathing, including inhalation (inspiration) and exhalation (expiration). It is a vital sign providing key information about respiratory and overall physiological health.

1. Rate (Frequency)

Counting: Number of breaths per minute (bpm). One breath equals one inhalation plus one exhalation. Count for a full minute, preferably when patient is resting and unaware (e.g., after pulse measurement).

Normal Resting Respiratory Rates

Age Group	Breaths per Minute
Adults (>18 years)	12-20 breaths/min
Adolescents (12-18 years)	12-16 breaths/min
School-age (6-12 years)	18-30 breaths/min
Preschooler (3-6 years)	22-34 breaths/min
Toddler (1-3 years)	24-40 breaths/min
Infant (birth-1 year)	30-60 breaths/min

Terminology

• Eupnea: Normal, quiet breathing.
• Tachypnea: Rapid breathing (>20 bpm in adults). Causes include fever, pain, anxiety, exercise, hypoxemia, lung conditions.
• Bradypnea: Slow breathing (<12 bpm in adults). Causes include medication overdose (opioids), neurological or metabolic issues.
• Apnea: Temporary cessation of breathing.

2. Rhythm

• Regular: Consistent intervals between breaths.
• Irregular: Inconsistent intervals, suggesting underlying issues.

3. Depth (Tidal Volume)

• Shallow: Small, inadequate breaths.
• Deep: Full, expansive breaths.
• Hyperventilation: Excessively deep and rapid breathing, lowering CO₂ levels.
• Hypoventilation: Slow or shallow breathing, increasing CO₂ levels.

4. Effort / Work of Breathing

• Non-labored/Effortless: Quiet, easy breathing.
• Labored/Difficult: Indicates respiratory distress. Signs include:
  • Accessory muscle use (neck, shoulders, intercostals)
  • Nasal flaring (especially in children)
  • Retractions (intercostal, supraclavicular, substernal)
  • Grunting (infants, to keep alveoli open)
  • Pursed-lip breathing (seen in COPD)
  • Paradoxical breathing (abdomen moves inward on inspiration)
  • Orthopnea (shortness of breath lying flat)
  • Tripod position (leaning forward to ease breathing)

5. Sounds

• Quiet: Normal breathing soundless or very faint.
• Audible: Sounds without stethoscope include:
  • Wheezing: high-pitched, often on exhalation (narrowed airways)
  • Stridor: harsh inspiratory sound (upper airway obstruction)
  • Gurgling/Rhonchi: coarse rattling from secretions
  • Cough: note sputum color, consistency, amount

6. Symmetry of Chest Movement

Chest should rise and fall equally on both sides. Asymmetry may indicate:

• Pneumothorax
• Pain-related splinting
• Unilateral lung disease

• Age (varies significantly in children vs adults)
• Activity level (increases with exertion)
• Pain (causes rapid shallow breathing)
• Anxiety/Fear (may cause hyperventilation)
• Fever (increases metabolic rate and respiratory rate)
• Medications (opioids depress, stimulants increase respiration)
• Metabolic status (acidosis increases rate, alkalosis decreases it)
• Neurological conditions affecting respiratory centers
• Pulmonary and cardiac conditions (e.g., asthma, COPD, heart failure)