Respiratory exam template: IPPA steps and documentation

Key takeaways

A respiratory exam follows the same four steps every time: inspection, palpation, percussion, and auscultation.

Normal means 12 to 20 breaths a minute, symmetrical expansion, a resonant percussion note, and vesicular breath sounds.

Record what you observed and where, not what you think it means, and always compare one side against the other.

Documentation has to support the level of service billed, so an incomplete exam note costs the practice twice.

Practice management software like Pabau turns the paper form into a digital template that writes straight into the patient record.

A respiratory exam is four steps in a fixed order: look, feel, tap, listen. Run them the same way every time and a quiet right base stands out in seconds. Skip one and you can miss the finding that changes the plan.

The order matters because each step answers a question the one before it raised. Percussion tells you whether the tissue underneath is air-filled. Auscultation tells you what is moving through it.

This page walks through the sequence and sets out normal against abnormal. It also shows how to write findings a colleague can act on.

What a respiratory exam actually tells you

It tells you how well air is moving in and out, and where it is not. The exam reads breathing pattern, chest wall mechanics, and the density of the tissue underneath. Together those three pick up infection, collapse, fluid, and trapped air before anyone orders imaging.

It is also fast. A full sequence takes 5 to 10 minutes, which is why it fits inside so many routine visits. Primary care, physical therapy, sports medicine, and occupational health all run some version of it.

The IPPA sequence, step by step

IPPA stands for inspection, palpation, percussion, and auscultation. Each step adds a layer the one before it could not reach. The chart below sets out what you do at each stage, and what a normal result looks like when you get there.

Step 1: Look before you touch

Observation comes first, while the patient is still settling. Watch the rate, the effort, and whether both sides of the chest move together.

• Breathing pattern: regular or irregular, easy or labored, typically 12 to 20 breaths per minute at rest
• Accessory muscle use: sternocleidomastoid and scalene recruitment points to respiratory distress
• Chest wall symmetry: both sides should rise together, so one-sided movement suggests pathology
• Skin color: cyanosis, a bluish tint, signals oxygen desaturation
• Clubbing: thickened fingertip pads point to chronic lung or heart disease
• Kyphosis or scoliosis: spinal curvature restricts rib expansion and reduces lung capacity

Step 2: Feel for expansion and fremitus

Palpation checks that both lungs fill equally. Place your hands on the front, sides, and back of the chest, then ask for a deep breath.

• Chest expansion: your hands should move apart 2 to 5 cm, and by the same amount on each side
• Tactile fremitus: feel the vibration as the patient speaks, since reduced fremitus suggests consolidation or pleural effusion
• Tenderness: note rib or muscle pain, which can limit the breath and confuse the rest of the exam

Step 3: Percuss to map air, fluid, and solid tissue

Percussion turns tissue density into sound. Lay one middle finger flat against the chest wall, then tap it with a finger from the other hand. Work down the chest and compare left against right at each level.

Step 4: Listen at every landmark

Auscultation names what the first three steps found. Place the diaphragm at the standard landmarks, listen through a full breath, and compare each spot with its opposite number.

• Vesicular sounds (normal): soft and rustling, heard over most of the lung fields during inspiration and early expiration
• Bronchial sounds (normal): louder, hollow and tubular, heard over the trachea and mainstem bronchi
• Bronchovesicular sounds (normal): intermediate sounds heard over the large airways
• Crackles (abnormal): short, discontinuous popping sounds that suggest fluid, infection, or fibrosis
• Wheezes (abnormal): continuous, high-pitched and musical, pointing to airway narrowing or obstruction
• Rhonchi (abnormal): continuous, low-pitched and snoring-like, pointing to secretions in the airways

Normal findings, and the ones that should worry you

Most of the exam is a comparison against a known baseline. The table below is the quick reference for filling in the form, and for deciding when a finding needs imaging or a referral.

One caution before you act on any single row. A lone abnormal reading rarely stands on its own. Read it against the rate, the pattern, and what the patient told you at the door.

Run this five-point check before the patient sits down

Five small things decide whether the exam is worth documenting. Sort them out before you start, rather than halfway through.

• Position: sit the patient upright with the back exposed, because the lower lobes are heard from behind
• Room noise: turn off the fan and close the door, since a quiet wheeze is easy to lose under it
• Baseline: open the last exam note first, so you can say whether a finding is new
• Rate: count the breaths yourself for a full minute, rather than copying the number from triage
• Landmarks: agree one sequence with your colleagues, so two clinicians describe the same spot the same way

That last point causes more confusion than the exam itself. “Right base” means one thing to the clinician who wrote it. It can mean something slightly different to whoever reads the note next. A shared naming convention fixes that in about a week.

Write findings a colleague can act on

Write what you observed and where you observed it. Save the interpretation for the assessment line underneath.

• Stay objective: “bilateral crackles at the lung bases”, never “patient has pneumonia”
• Name the location: which lobe, which side, and whether the sound shifts with position or a cough
• State the comparison: “equal breath sounds bilaterally”, or “decreased breath sounds at the right base”
• Mark the normal sections: a checkbox or a “within normal limits” field beats an empty space
• Record the numbers: the respiratory rate you counted, and the pattern you saw while counting it
• Set it against baseline: say whether the finding is new, unchanged, or worse than last visit

Structure does most of that work for you. A form with named fields collects the same detail from every clinician, and that is the biggest single lever on note quality.

Practice management software like Pabau builds the form once and reuses it at every visit. Our guide to safer clinical notes covers the wider habits that go with it.

Where abnormal findings take you next

An abnormal exam narrows the differential. It does not close it. Dullness at a base, unequal breath sounds, or crackles that do not clear with a cough all point toward further testing.

Chest X-ray, spirometry, and blood work are the usual next moves. When oxygenation is the question rather than mechanics, an ABG chart keeps the gas results next to the exam that prompted them.

Whatever you order, write down why you ordered it. The completed form plus one line of reasoning is what makes the referral defensible six months later.

What your documentation has to prove at billing time

The note has to support the level of service you billed. A problem-focused exam and a comprehensive one look different on paper, and the difference is the detail you recorded at the time.

It also has to justify anything you ordered off the back of it. An imaging request reads far better when the note above it names the dull base and describes how the breath sounds compared.

A structured form helps here for a plain reason: it leaves visible blanks. An empty field is easy to catch before the visit closes. A missing paragraph is not.

How Pabau turns the respiratory exam into a reusable digital form

Plenty of practices still print the form. Someone completes it at the bedside, then types the findings into the record afterward. Or the paper gets filed, and nobody sees it again. Both routes cost time and lose detail.

In Pabau, the exam becomes a clinical note template with named fields. Clinicians pick findings from a list or type free text, and the note attaches to the patient record as they save it. There is no second round of data entry.

That changes what happens next. The findings sit in the record as structured fields, so you can pull the last exam up beside today’s. A follow-up task can fire automatically when a section comes back abnormal. The note itself drops into a referral letter without retyping.

Pabau is built for the whole visit, not only the note. Practices doing general medical work know it as GP clinic software. The same clinical note templates run in physical therapy and sports medicine practices too.

Turn the exam form into a reusable template

Pabau’s clinical note templates and digital forms capture respiratory exam findings straight into the patient record. Follow-up tasks fire automatically when a section comes back abnormal.

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Conclusion

The value of a respiratory exam sits in the repetition. The same four steps, in the same order, at every visit, is what makes an unequal finding obvious rather than debatable.

The trade-off is small. A few minutes of structure at the bedside buys a note that survives a referral and an audit. Download the template, run it the same way for a month, and the habit sticks.

Once the form works on paper, the next step is getting it off paper. Book a demo to see how Pabau turns your exam form into a digital note that files itself.

Continue your research

Want to catch deterioration earlier? Abnormal vital signs chart sets the thresholds that turn a rising respiratory rate into an escalation.

Found a wheeze that keeps coming back? Asthma action plan template gives the patient written steps for good days, bad days, and emergencies.

Recording the systems you did not examine? Normal review of systems has copy-ready wording for documenting 14 systems as negative.

Building out the full annual visit? Annual physical exam checklist sets out the vitals, labs, and screenings to run at each life stage.

Need a care plan after an abnormal exam? Ineffective breathing pattern care plan turns the findings into goals, interventions, and review points.

Frequently asked questions