Monitoring respiratory rate in adults

This article outlines the monitoring of respiratory rates in adult patients. This is a significant physical assessment skill, because breathing is usually the first vital sign to alter in the deteriorating patient (Hunter and Rawlings-Anderson, 2008). Ascertaining a baseline respiration function will permit an accurate respiration assessment to be carried out, tailored to the individual patient (Simpson, 2006).

The respiratory rate is the movement of air in and out of the lungs. This is described as ventilation, with a breath in referred to as inspiration and a breath out referred to as expiration. The observation and recording of respiratory rate is the numerical calculation of breaths per minute (bpm) and informs the overall physical assessment of respiration. Assessment and recording of respiratory rate must be accurate and is an essential nursing skill. Evidence suggests that, of all the vital signs, change in respiratory rate is an early sign of deterioration

According to the British Lung Foundation (2020), the four main causes of breathlessness are:

• lung conditions
• heart conditions
• anxiety
• being unfit

An initial Airway, Breathing, Circulation assessment should be performed in a patient presenting with breathlessness. The person's blood pressure, pulse, respiratory rate, temperature, level of consciousness, peak expiratory flow rate and oxygen saturation should be assessed and, if possible, an electrocardiogram performed.

People with the following symptoms should be admitted as an emergency:

• severe or life-threatening acute asthma attack (follow-up in the community is essential after discharge)

• features of a pulmonary embolus or pneumothorax

• rapid onset or worsening of symptoms of suspected heart failure

• suspected sepsis

• electrocardiogram suggesting a cardiac arrhythmia or myocardial infarction

Emergency hospital assessment should also be considered for people with:

• suspected community-acquired pneumonia

• an exacerbation of chronic obstructive pulmonary disease

• breathlessness with an unclear cause

The following features are associated with the presence or risk

Normal respiratory rate in an adult is 12-18 bpm. Expiration, breathing out, takes twice as long as the breath in, or inspiration (Dougherty and Lister, 2011). One breath should be counted for every breath in (inhalation) and breath out (exhalation).

When assessing a patient's respiratory rate, it is important to place the numerical value in the context of the patient's presenting condition and symptoms. Normal values only establish a baseline that would be expected in a healthy adult and give the nurse a reference point from which to make a comparison and determine the patient's usual respiratory rate (Table 1). 

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2.1 take, record and interpret vital signs manually and via technological devices

2.7 undertake a whole body systems assessment including respiratory, circulatory, neurological, musculoskeletal, cardiovascular and skin status

Part 2: Procedures for the planning, provision and management of person-centred nursing care

8.1 observe and assess the need for intervention and respond to restlessness, agitation and breathlessness using appropriate interventions

British Lung Foundation. What causes breathlessness? 2020. https://www.blf.org.uk/support-for-you/breathlessness/causes (accessed 27 October 2023) 

British Thoracic Society and Scottish Intercollegiate Guidelines Network. BTS/SIGN guideline for the management of asthma. SIGN 158. 2021. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ (accessed 27 October 2023) 

Cretikos MA, Bellomo R, Hillman K et al. Respiratory rate: the neglected vital sign. Med J Aust. 2008;188(11):657-659. https://doi.org/10.5694/j.1326-5377.2008.tb01825.x 

Dougherty L, Lister S. The Royal Marsden manual of clinical nursing procedures. Student edition. 8th edn. Oxford: Wiley-Blackwell; 2011 

Hunter J, Rawlings-Anderson K. Respiratory assessment. Nurs Stand. 2008;22(41):41–43. https://doi.org/10.7748/ns2008.06.22.41.41.c6576 

Kelly C. Respiratory rate 1: why accurate measurement and recording are crucial. Nurs Times. 2018;114(4):23–24 

National Clinical Guideline Centre. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update of CG12) (full original NICE guideline). 2010. https://www.nice.org.uk/guidance/ng115/evidence/june-2010-full-guideline-pdf-6602767453 (accessed 27 October 2023) 

National Institute for Health and Care Excellence. Breathlessness. 2022a. https://cks.nice.org.uk/breathlessness#!scenario (accessed 27 October 2023)

National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115. 2019.