The WOB medical abbreviation means work of breathing, the amount of effort a person uses to move air in and out of the lungs. Notes usually describe it as normal, unlabored, or increased.
Nurses, respiratory therapists and doctors write it in nearly every lung or breathing assessment, and it carries special weight in children, where visible effort is often the earliest clue to trouble. This page explains what clinicians look for, how to read common phrases, and how WOB differs from shortness of breath and breathing rate.
At a glance
Stands for
Work of breathingCommon phrases
No increased WOB; mild, moderate or severe increased WOBSigns of increased WOB
Retractions, nasal flaring, accessory muscle use, gruntingWhere you see it
Respiratory assessments, pediatric and emergency notesUsed by
Nurses, respiratory therapists, physiciansDo not confuse with
SOB, a symptom the person reports
What the WOB medical abbreviation describes
Quiet breathing at rest takes very little effort. The diaphragm does most of the job, and the person can talk in full sentences without pausing. When the lungs are stiff, the airways are narrow, or the body needs more oxygen, breathing takes more effort. Clinicians judge that effort by watching and listening, so WOB is an observed finding rather than a lab number.
In physiology classes, work of breathing also has a technical meaning: the energy the breathing muscles spend to overcome airway resistance and lung stiffness. Bedside notes use the plain sense of visible effort.
Signs of increased work of breathing
These are the signs that lead a clinician to chart increased WOB.
| Sign | What it looks or sounds like |
|---|---|
| Retractions | Skin pulling in between or below the ribs, or above the collarbone |
| Accessory muscle use | Neck and shoulder muscles working with each breath |
| Nasal flaring | Nostrils widening as the person breathes in, common in infants |
| Grunting | A short sound at the end of each breath out, mostly in babies |
| Tripod position | Sitting forward with hands on knees to breathe more easily |
| Speaking in short phrases | Unable to finish a sentence without pausing |
A fast breathing rate often appears alongside these signs, but rate and effort are charted separately.
Reading WOB in a real assessment
Adult floor note: "Lungs CTAB, no increased WOB, SpO2 97% on RA." The lungs sound clear on both sides (CTAB), breathing looks easy, and oxygen saturation is 97 percent on room air.
Pediatric emergency note: "Moderate increased WOB with subcostal retractions and nasal flaring, RT at bedside." The child is working hard to breathe, with skin pulling in below the ribs, and a respiratory therapist has been called.
Many charts grade the effort as mild, moderate or severe, and some pediatric units use a scored respiratory assessment tool.
WOB, SOB and respiratory rate are not the same
These three are easy to blur together.
| Term | Who reports it | What it means |
|---|---|---|
| WOB | The clinician observes it | Visible effort to breathe |
| SOB | The person describes it | The feeling of being short of breath |
| RR | The clinician counts it | Breaths per minute |
A person can feel short of breath with little visible effort, or a sleepy child can be tiring out with a slow rate, so notes list each one. Breathlessness with activity has its own shorthand, DOE.
Why changes in effort get attention
Increased effort can come with asthma, pneumonia, bronchiolitis in infants, heart failure, a blood clot in the lung or many other problems. Rising effort over time tells the team that treatment may need to change, while easing effort suggests things are improving. Staff may check blood gases (ABG) or adjust oxygen based on what they see along with other findings.
Charting tips for students
Describe what you see instead of only writing increased WOB: name the retractions and where they are, and note flaring, grunting or accessory muscle use. Record whether the person can speak in full sentences. Chart rate and oxygen saturation in the same entry. Find more assessment shorthand in the chart and nursing abbreviation hub.
These are general descriptions of what clinicians observe. If breathing ever looks hard for you or your child, seek care right away and let the care team assess it.
Frequently asked questions
What does increased WOB mean?
It means a person is using more effort than normal to breathe. Signs include retractions, nasal flaring, neck muscle use and needing to pause while speaking.
What does no increased WOB mean in a note?
It means breathing looked easy and unlabored when the clinician examined the person. It is a normal finding.
Is WOB the same as shortness of breath?
No. Work of breathing is what a clinician sees, while shortness of breath is what the person feels. A note may list both because they do not always match.
What do retractions look like?
The skin pulls inward between the ribs, under the rib cage or above the collarbone with each breath in. They are easiest to see in babies and young children.