From a midline position behind the patient, note the shape of the chest and the way in which it moves, including:

■ Deformities or asymmetry

■ Abnormal retraction of the interspaces during inspiration. Retraction is most apparent in the lower interspaces. Supraclavicular retraction is often associated.

See Table 6-4, Deformities of the Thorax (p. 239).

Retraction in severe asthma, COPD, or upper airway obstruction.

■ Impaired respiratory movement on one or both sides or a unilateral lag (or delay) in movement.

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