2. What the clinician must assess

A complete assessment addresses each of the following each visit, scaled to the patient's diagnosis and stability:

• Respiratory rate, pattern, and effort, observed over a full minute.
• Work of breathing — accessory-muscle use, retractions, nasal flaring, pursed-lip breathing, and tripod posture.
• Breath sounds in all fields — clear, crackles (fine or coarse), wheezes, rhonchi, diminished, absent, or a pleural rub.
• Oxygenation — SpO2 on room air and on oxygen, with the delivery device and flow documented.
• Cough and sputum — presence, productivity, color, amount, viscosity, and any hemoptysis.
• Dyspnea — at rest versus exertion, the distance or activity to symptom, orthopnea, and PND.
• Speech — full sentences versus fragmented speech; mental-status change suggesting hypoxia or hypercapnia.
• Chest-expansion symmetry; cyanosis; digital clubbing.
• Respiratory device use and technique — inhaler, spacer, nebulizer, oxygen, CPAP or BiPAP.
• Medication regimen — bronchodilators, inhaled corticosteroids, oxygen, mucolytics, and antibiotics: adherence, effect, and adverse effects.
• Functional and activity tolerance; smoking status and environmental exposures.