Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center

Disorders of the respiratory system with a chief complaint of shortness of breath are among the most common reasons for both outpatient and inpatient evaluation. The most obvious visible clue to a respiratory problem will be whether the patient is displaying any signs of respiratory distress, such as fast respiratory rate and/or cyanosis. In a clinical situation, this will always require emergent attention and oxygen therapy.

Unlike pathology in other body systems, many pulmonary disorders, including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, can be diagnosed by careful clinical examination alone. This starts with a comprehensive inspection and palpation. Keep in mind that in non-emergency situations the patient's complete history will have been taken already, gaining important insight into exposure histories (e.g., smoking), which could give rise to specific lung diseases. This history can then confirm physical findings as the examination is performed.

1. Preparation for exam

1. Before examining the patient, wash hands thoroughly with soap and water or clean them with antibacterial wash.
2. Explain to the patient that you are going to perform a lung examination.

2. Positioning the patient

1. Make sure the patient is undressed down to the waist (females keeping on underwear and exposing each hemithorax one at a time).
2. Position the patient on the examination table at a 30- to 45-degree angle and approa

Look first and foremost for any signs of respiratory distress in a patient and unique breathing pattern. Severe underlying pulmonary illnesses will often be apparent from simply glancing at patients. Conditions such as COPD and emphysema can reveal themselves in a patient's appearance and body habitus. These patients can loosely be classified as either "pink puffers" or "blue bloaters." "Pink puffers" are usually thin and have emphysema. They have a hyper-infla