[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [General exam and vital signs](https://durgical.com/en/clinical-exam/#a-general) › Respiratory rate and breathing patterns

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# 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](https://durgical.com/en/anatomy/diaphragm/) · [Medulla oblongata](https://durgical.com/en/anatomy/medulla-oblongata/) · [Pons](https://durgical.com/en/anatomy/pons/)

## Key points

- Resting adult: 12 to 20 per minute. Tachypnea above 20; bradypnea below 12; apnea is the absence of breathing.
- Kussmaul: deep, regular breathing from metabolic acidosis, classic in diabetic ketoacidosis.
- Cheyne-Stokes: cycles that build up and die down in rate and depth separated by brief apneas; heart failure, stroke, advanced dementia and drugs.
- Biot: four or five deep, equal breaths alternating with irregular apneas, with no periodicity; central nervous system injury, as in meningitis.
- Bradypnea with drowsiness suggests respiratory depression from opioids or sedatives.
- A high respiratory rate is an early sign of deterioration and scores in both NEWS2 and qSOFA.

## 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

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

## Memory aid

Kussmaul is 'big and deep', blowing off the acid; Cheyne-Stokes 'climbs, falls and goes quiet'.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/respiratory-rate-and-breathing-patterns/)

## See it in 3D

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

- [Diaphragm](https://durgical.com/en/anatomy/diaphragm/)
- [Medulla oblongata](https://durgical.com/en/anatomy/medulla-oblongata/)
- [Pons](https://durgical.com/en/anatomy/pons/)

## Related

- [Vital signs: what they are and how to record them](https://durgical.com/en/clinical-exam/vital-signs-what-they-are-and-how-to-record-them/)
- [Chest inspection: shape, expansion, accessory muscles and retractions](https://durgical.com/en/clinical-exam/chest-inspection-shape-expansion-accessory-muscles-and-retractions/)
- [Respiratory distress and respiratory failure: the signs](https://durgical.com/en/clinical-exam/respiratory-distress-and-respiratory-failure-the-signs/)
- [Pulse oximetry](https://durgical.com/en/clinical-exam/pulse-oximetry/)

## Related conditions

- [Diabetic ketoacidosis](https://durgical.com/en/conditions/diabetic-ketoacidosis/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Opioid overdose](https://durgical.com/en/conditions/opioid-overdose/)
- [Acute respiratory failure (hypoxaemic and hypercapnic)](https://durgical.com/en/conditions/acute-respiratory-failure/)

[← All of the clinical exam](https://durgical.com/en/clinical-exam/)

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](https://openstax.org/books/clinical-nursing-skills/pages/15-6-respiration) (OpenStax, Rice University, 2024); [Evaluation of the Patient With Pulmonary Issues - Pulmonology - MSD Manual Professional Edition](https://www.msdmanuals.com/professional/pulmonary-disorders/approach-to-the-pulmonary-patient/evaluation-of-the-patient-with-pulmonary-issues) (Merck & Co. (MSD Manual Professional Edition), 2025); [Vital signs: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002341.htm) (U.S. National Library of Medicine (MedlinePlus), 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/respiratory-rate-and-breathing-patterns/