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Clinical exam · General exam and vital signs

Respiratory rate and breathing patterns !

  • Vital sign

How many times a patient breathes per minute, how deeply and how regularly, and which abnormal patterns to recognise.

Updated 2026-11-01

See it in 3D: Diaphragm · Medulla oblongata · Pons

What it is

Respiratory rate is the number of breathing cycles per minute; depth, rhythm and effort are assessed as well. It is the vital sign most often skipped and one of the first to change when a patient deteriorates. Certain patterns (Kussmaul, Cheyne-Stokes, Biot) point to metabolic acidosis, heart failure or central nervous system injury.

Reference values

  • Adult: 12 to 20 breaths per minute (MedlinePlus gives 12 to 18).
  • Tachypnea: more than 20 per minute. Bradypnea: fewer than 12 per minute.
  • Accessory muscles are not used at rest; their use is always recorded.

Structure

  • The breathing rhythm is generated in the medulla oblongata and modulated by the pons.
  • Chemoreceptors respond to carbon dioxide and pH (central) and to oxygen (peripheral, in the carotid body).
  • The diaphragm is the main inspiratory muscle; the sternocleidomastoids and scalenes are accessory muscles.

How to measure it

  1. Count straight after the pulse, fingers still on the wrist, so the patient does not notice being watched.
  2. Watch the chest or abdomen rise; each inspiration plus its expiration is one cycle.
  3. Count a full minute, especially when breathing is irregular or slow or in young children, because some patterns change the rate.
  4. Assess depth (shallow, normal, deep) and whether expansion is symmetric.
  5. Look at effort: nasal flaring, use of sternocleidomastoids and scalenes, intercostal retractions, paradoxical breathing or tripod position.
  6. Describe the rhythm and any pauses or cyclic pattern, timing the apneas.
  7. Record the rate, the method (visual or stethoscope) and the oxygen saturation with it.

What abnormal values mean

  • Tachypnea: fever, pain, anxiety, pneumonia, asthma, pulmonary embolism, heart failure, sepsis and metabolic acidosis.
  • Bradypnea: opioids, sedatives, hypothermia, severe hypothyroidism and raised intracranial pressure.
  • Shallow breathing: chest or abdominal pain (after surgery), with a risk of atelectasis.
  • Kussmaul: diabetic ketoacidosis, uremia and other metabolic acidoses.
  • Cheyne-Stokes: heart failure, stroke, advanced dementia and some drugs.
  • Biot: central nervous system injury (meningitis, trauma, brainstem lesions).

Common errors

  • Telling the patient their breathing is being counted.
  • Guessing the rate instead of counting it: it is the vital sign most often made up.
  • Counting only a few seconds of irregular breathing or breathing with pauses.
  • Not recording breathing effort when the number looks normal.

Test yourself

Think of the answer, then tap the question to see it.

Which breathing pattern is characteristic of diabetic ketoacidosis?

Kussmaul breathing: deep and regular, a respiratory compensation for metabolic acidosis.

How is Cheyne-Stokes breathing told apart from Biot breathing?

In Cheyne-Stokes, breathing waxes and wanes cyclically between brief apneas; in Biot, groups of deep, equal breaths stop abruptly with irregular apneas, without that cyclic pattern.

Why are breaths counted with the fingers still on the pulse?

So the patient thinks the pulse is still being taken and does not consciously change their breathing.

What does bradypnea suggest in a drowsy patient receiving opioids?

Opioid-induced respiratory depression; it is a finding to report immediately.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: 15.6 Respiration - Clinical Nursing Skills | OpenStax (OpenStax, Rice University, 2024); Evaluation of the Patient With Pulmonary Issues - Pulmonology - MSD Manual Professional Edition (Merck & Co. (MSD Manual Professional Edition), 2025); Vital signs: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine (MedlinePlus), 2025).

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Representative model, for educational purposes only.