Which finding indicates increased work of breathing during pulmonary inspection?

• A. Rate
• B. Trachea midline
• C. Retractions/use of accessory muscles
• D. AP diameter barrel chest

Answer: (C)

The main concept is recognizing signs of increased work of breathing on inspection, which is most clearly shown by retractions and use of accessory muscles. When airways are obstructed or lung compliance is reduced, the body recruits muscles beyond the diaphragm—such as the sternocleidomastoid and scalene muscles—to help pull air into the lungs. This extra effort pulls the chest wall inward in areas like the suprasternal and intercostal regions, producing visible retractions. Those visible efforts reflect higher energy expenditure and greater work required to breathe, signaling respiratory distress. In contrast, a fast rate by itself can occur with anxiety or fever and doesn’t necessarily mean greater work of breathing, and a midline trachea or an exaggerated AP diameter points to anatomical or chronic changes rather than acute increased effort. So observing retractions or accessory muscle use is the best indicator that the patient is working harder to breathe.