Respiratory ExaminationEdit

Respiratory examination is the clinical process by which a clinician assesses the lungs and airways through observation, touch, and listening. It sits at the intersection of history, physiology, and practical judgment, helping distinguish common problems such as infections, obstructive disease, and acute emergencies. In settings that prize efficiency and patient-centered care, the bedside examination remains a core skill: it guides triage, informs the choice and timing of tests, and sets the tone for how care is delivered.

This article describes a pragmatic, skill-based approach to the respiratory exam. It emphasizes clear technique, careful documentation, and interpretation of findings in the context of a patient’s risk factors and presentation. The goal is to identify when conservative management is appropriate, when urgent imaging or intervention is needed, and how to communicate findings clearly to patients and other clinicians. Along the way, it addresses some of the contemporary debates about bedside assessment and its role alongside imaging and laboratory studies.

Core techniques of the respiratory examination

History and general assessment

Key symptoms include cough, dyspnea, chest pain, sputum production, fever, and hemoptysis. Each symptom suggests different etiologies, from viral bronchitis to pneumonia or hemorrhagic processes. See Cough, Dyspnea, Hemoptysis, Fever.
Risk factors shape likelihoods: smoking, occupational exposures, prior respiratory disease, and recent travel or infection history. See Smoking, Occupational exposure.
Vital signs and general appearance help stratify urgency. Look for fever, tachypnea, tachycardia, hypoxia, and signs of systemic illness. See Vital signs and Pulse oximetry.

Inspection

Observe breathing pattern and work of breathing. Use of accessory muscles, nasal flaring, and the rate of respiration provide immediate clues about respiratory compromise. See Work of breathing.
Posture and chest wall configuration can reveal chronic disease or acute distress. Watch for tripod position, chest wall deformities, scars, and asymmetry.
Look for color changes such as cyanosis and for signs of systemic illness or dehydration. See Cyanosis and Clubbing.

Palpation

Palpation assesses chest expansion symmetry and tactile feedback from the chest wall. Reduced expansion can indicate focal disease or pleural processes; asymmetry may point to localized pathology. See Chest expansion.
Tactile fremitus (vibrations transmitted through the chest with speech) can help distinguish dense from air-filled areas. See Tactile fremitus.

Percussion

Percussion helps classify the underlying tissue: resonant lungs suggest air-filled spaces, dullness may reflect consolidation or effusion, and hyper-resonance can indicate air trapping or pneumothorax. See Percussion (medicine).

Auscultation

Breath sounds vary across locations and patient factors. Vesicular sounds are common in healthy lungs; adventitious sounds such as crackles, wheezes, and rhonchi can indicate edema, obstruction, or infection. See Auscultation and Breath sounds.
Special auscultatory techniques include eliciting egophony and whispered pectoriloquy to detect subtle consolidations. See Egophony and Whispered pectoriloquy.
The clinician should note the presence or absence of pleural rubs and pleural effusion-related changes.

Focused bedside tests and interpretation

Oxygen saturation via pulse oximetry (SpO2) provides a quick snapshot of gas exchange. See Pulse oximetry.
Brief tests of speech and phonation can complement auscultation to localize pathology. See Egophony.
In selected cases, arterial blood gas (ABG) or venous blood gas measurements help quantify respiratory failure. See Arterial blood gas.
Point-of-care imaging and ultrasound, when available, can augment the exam and speed diagnosis. See Point-of-care ultrasound.

Documentation and interpretation

Record presenting symptoms, vital signs, and the sequence of findings (inspection, palpation, percussion, auscultation) alongside a concise differential diagnosis.
Correlate exam findings with imaging studies (e.g., chest radiographs or CT scans) and laboratory data to refine the diagnosis and guide management.

Patterns and common clinical syndromes

Obstructive patterns often present with wheeze on auscultation and may relate to asthma or chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease). See Wheezes.
Infiltrative patterns may show crackles and signs of consolidation consistent with Pneumonia.
Pleural processes can cause decreased breath sounds, dull percussion, and restricted expansion, with potential findings such as Pleural effusion or Pneumothorax.
Pulmonary edema may produce diffuse crackles and hypoxia, reflecting fluid overload or cardiac dysfunction. See Pulmonary edema.

Contemporary debates and controversies

The enduring value of the bedside exam versus imaging: Some clinicians argue that modern imaging and laboratory tests can rapidly yield objective data, reducing reliance on auscultation and physical signs. Proponents of a disciplined exam counter that a skilled bedside assessment can rapidly triage patients, reduce unnecessary imaging, build patient trust, and lower costs. The best practice often blends both approaches, using the exam to guide imaging, rather than letting imaging replace clinical skills. See Chest radiography and Computed tomography.
The role of lung ultrasound and other point-of-care tools: With advances in handheld ultrasound, clinicians can detect pleural effusions, consolidations, and pneumothorax at the bedside, sometimes faster than radiographs. This has led to a shift in some settings toward greater reliance on ultrasound as an adjunct to the traditional exam. See Lung ultrasound and Point-of-care ultrasound.
Adapting to resource constraints: In settings with limited access to imaging, a rigorous bedside examination becomes even more critical. Clinicians may rely more on history, exam, and simple tests (SpO2, spirometry where available) to decide on treatment and the urgency of referral. See Spirometry.
Controversies around terminology and inclusivity in medical discourse: In professional discourse, there are ongoing debates about language and patient-centered communication. This article frames the exam as a practical toolkit for bedside care and decision-making, rather than endorsing any broader social narrative. See Medical terminology.
Response to criticisms of over-testing: Critics argue that over-testing drives up costs and patient exposure to radiation. Proponents of a careful exam emphasize that patient-specific testing, when guided by exam findings and risk factors, can minimize unnecessary tests while preserving safety and speed of care. See Radiation exposure and Clinical decision making.
Woke criticism is often a distraction from patient care: Critics of political correctness argue that focusing on equity or social narratives can slow down the delivery of timely, evidence-based care. A practical stance is to prioritize clear communication, prompt assessment, and cost-effective decision-making, while recognizing the need to treat all patients with respect and without discrimination. The core aim remains improving health outcomes through disciplined clinical practice. See Healthcare disparities.