Air movement in severe cases of chronic obstructive pulmonary disease (COPD) is accomplished in part by the accessory muscles of respiration. Conspicuous contraction of the taut sternomastoid muscle has been considered one of the important signs of airways obstruction. The clavicle, and with it, the upper thoracic cage, is lifted more than 5 mm by the contraction of the sternomastoid muscle, even during quiet breathing. Studies have shown forced expiratory volume in 1 second (FEV1) in such individuals to be 0.8 liter or less. By simple inspection and measurement of the clavicular lift, one can predict FEV1 in patients with COPD who are not in acute respiratory distress.
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