Respiratory Therapists

• Job opportunities will be very good, especially for therapists with cardiopulmonary care skills or experience working with infants.
• All States (except Alaska and Hawaii), the District of Columbia, and Puerto Rico require respiratory therapists to obtain a license.
• Hospitals will continue to employ the vast majority of respiratory therapists, but a growing number of therapists will work in other settings.

Respiratory therapists and respiratory therapy technicians—also known as respiratory care practitioners—evaluate, treat, and care for patients with breathing or other cardiopulmonary disorders. Practicing under the direction of a physician, respiratory therapists assume primary responsibility for all respiratory care therapeutic treatments and diagnostic procedures, including the supervision of respiratory therapy technicians. Respiratory therapy technicians follow specific, well-defined respiratory care procedures under the direction of respiratory therapists and physicians. In clinical practice, many of the daily duties of therapists and technicians overlap; furthermore, the two have the same education and training requirements. However, therapists generally have greater responsibility than technicians. For example, respiratory therapists will consult with physicians and other health care staff to help develop and modify individual patient care plans. Respiratory therapists also are more likely to provide complex therapy requiring considerable independent judgment, such as caring for patients on life support in intensive-care units of hospitals. In this Handbook statement, the term respiratory therapists includes both respiratory therapists and respiratory therapy technicians.

Respiratory therapists evaluate and treat all types of patients, ranging from premature infants whose lungs are not fully developed to elderly people whose lungs are diseased. Respiratory therapists provide temporary relief to patients with chronic asthma or emphysema, as well as emergency care to patients who are victims of a heart attack, stroke, drowning, or shock.

To evaluate patients, respiratory therapists interview them, perform limited physical examinations, and conduct diagnostic tests. For example, respiratory therapists test patients’ breathing capacity and determine the concentration of oxygen and other gases in patients’ blood. They also measure patients’ pH, which indicates the acidity or alkalinity of the blood. To evaluate a patient’s lung capacity, respiratory therapists have the patient breathe into an instrument that measures the volume and flow of oxygen during inhalation and exhalation. By comparing the reading with the norm for the patient’s age, height, weight, and sex, respiratory therapists can provide information that helps determine whether the patient has any lung deficiencies. To analyze oxygen, carbon dioxide, and pH levels, therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician, who then may make treatment decisions.

To treat patients, respiratory therapists use oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications. When a patient has difficulty getting enough oxygen into his or her blood, therapists increase the patient’s concentration of oxygen by placing an oxygen mask or nasal cannula on the patient and set the oxygen flow at the level prescribed by a physician. Therapists also connect patients who cannot breathe on their own to ventilators that deliver pressurized oxygen into the lungs. The therapists insert a tube into the patient’s trachea, or windpipe; connect the tube to the ventilator; and set the rate, volume, and oxygen concentration of the oxygen mixture entering the patient’s lungs.

Therapists perform regular assessments of patients and equipment. If the patient appears to be having difficulty breathing or if the oxygen, carbon dioxide, or pH level of the blood is abnormal, therapists change the ventilator setting according to the doctor’s orders or check the equipment for mechanical problems. In home care, therapists teach patients and their families to use ventilators and other life-support systems. In addition, therapists visit patients several times a month to inspect and clean equipment and to ensure its proper use. Therapists also make emergency visits if equipment problems arise.

Respiratory therapists perform chest physiotherapy on patients to remove mucus from their lungs and make it easier for them to breathe. For example, during surgery, anesthesia depresses respiration, so chest physiotherapy may be prescribed to help get the patient’s lungs back to normal and to prevent congestion. Chest physiotherapy also helps patients suffering from lung diseases, such as cystic fibrosis, that cause mucus to collect in the lungs. Therapists place patients in positions that help drain mucus, and then vibrate the patients’ rib cages and instruct the patients to cough.

Respiratory therapists also administer aerosols—liquid medications suspended in a gas that forms a mist which is inhaled—and teach patients how to inhale the aerosol properly to ensure its effectiveness.

In some hospitals, therapists perform tasks that fall outside their traditional role. Therapists’ tasks are expanding into areas such as pulmonary rehabilitation, smoking cessation counseling, disease prevention, case management, and polysomnography—the diagnosis of breathing disorders during sleep, such as apnea. Respiratory therapists also increasingly treat critical care patients, either as part of surface and air transport teams or as part of rapid-response teams in hospitals.

Respiratory therapists generally work between 35 and 40 hours a week. Because hospitals operate around the clock, therapists may work evenings, nights, or weekends. They spend long periods standing and walking between patients’ rooms. In an emergency, therapists work under a great deal of stress. Respiratory therapists employed in home health care must travel frequently to the homes of patients.

Respiratory therapists are trained to work with hazardous gases stored under pressure. Adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of injury. As in many other health occupations, respiratory therapists run the risk of catching an infectious disease, but carefully following proper procedures minimizes this risk.

Formal training is necessary for entry into this field. Training is offered at the postsecondary level by colleges and universities, medical schools, vocational-technical institutes, and the Armed Forces. An associate’s degree is required for entry into the field. Most programs award associate’s or bachelor’s degrees and prepare graduates for jobs as advanced respiratory therapists. A limited number of associate’s degree programs lead to jobs as entry-level respiratory therapists. According to the Commission on Accreditation of Allied Health Education Programs (CAAHEP), 51 entry-level and 329 advanced respiratory therapy programs were accredited in the United States, including Puerto Rico, in 2005.

Among the areas of study in respiratory therapy are human anatomy and physiology, pathophysiology, chemistry, physics, microbiology, pharmacology, and mathematics. Other courses deal with therapeutic and diagnostic procedures and tests, equipment, patient assessment, cardiopulmonary resuscitation, the application of clinical practice guidelines, patient care outside of hospitals, cardiac and pulmonary rehabilitation, respiratory health promotion and disease prevention, and medical recordkeeping and reimbursement.

The National Board for Respiratory Care (NBRC) offers certification and registration to graduates of programs accredited by CAAHEP or the Committee on Accreditation for Respiratory Care (CoARC). Two credentials are awarded to respiratory therapists who satisfy the requirements: Registered Respiratory Therapist (RRT) and Certified Respiratory Therapist (CRT). Graduates from accredited entry-level or advanced-level programs in respiratory therapy may take the CRT examination. CRTs who were graduated from advanced-level programs and who meet additional experience requirements can take two separate examinations leading to the award of the RRT credential.

All States (except Alaska and Hawaii), the District of Columbia, and Puerto Rico require respiratory therapists to obtain a license. Passing the CRT exam qualifies respiratory therapists for State licenses. Also, most employers require respiratory therapists to maintain a cardiopulmonary resuscitation (CPR) certification. Supervisory positions and intensive-care specialties usually require the RRT or at least RRT eligibility.

Therapists should be sensitive to patients’ physical and psychological needs. Respiratory care practitioners must pay attention to detail, follow instructions, and work as part of a team. In addition, operating advanced equipment requires proficiency with computers.

High school students interested in a career in respiratory care should take courses in health, biology, mathematics, chemistry, and physics. Respiratory care involves basic mathematical problem solving and an understanding of chemical and physical principles. For example, respiratory care workers must be able to compute dosages of medication and calculate gas concentrations.

Respiratory therapists advance in clinical practice by moving from general care to the care of critically ill patients who have significant problems in other organ systems, such as the heart or kidneys. Respiratory therapists, especially those with bachelor’s or master’s degrees, also may advance to supervisory or managerial positions in a respiratory therapy department. Respiratory therapists in home health care and equipment rental firms may become branch managers. Some respiratory therapists advance by moving into teaching positions.

Respiratory therapists held about 118,000 jobs in 2004. More than 4 out of 5 jobs were in hospital departments of respiratory care, anesthesiology, or pulmonary medicine. Most of the remaining jobs were in offices of physicians or other health practitioners, consumer-goods rental firms that supply respiratory equipment for home use, nursing care facilities, and home health care services. Holding a second job is relatively common for respiratory therapists. About 13 percent held another job, compared with 5 percent of workers in all occupations.

Job opportunities are expected to be very good, especially for respiratory therapists with cardiopulmonary care skills or experience working with infants. Employment of respiratory therapists is expected to increase faster than average for all occupations through the year 2014, because of substantial growth in the numbers of the middle-aged and elderly population—a development that will heighten the incidence of cardiopulmonary disease—and because of the expanding role of respiratory therapists in the early detection of pulmonary disorders, case management, disease prevention, and emergency care.

Older Americans suffer most from respiratory ailments and cardiopulmonary diseases such as pneumonia, chronic bronchitis, emphysema, and heart disease. As their numbers increase, the need for respiratory therapists will increase as well. In addition, advances in inhalable medications and in the treatment of lung transplant patients, heart attack and accident victims, and premature infants (many of whom are dependent on a ventilator during part of their treatment) will increase the demand for the services of respiratory care practitioners.

Although hospitals will continue to employ the vast majority of therapists, a growing number can expect to work outside of hospitals in home health care services, offices of physicians or other health practitioners, or consumer-goods rental firms.

Median annual earnings of respiratory therapists were $43,140 in May 2004. The middle 50 percent earned between $37,650 and $50,860. The lowest 10 percent earned less than $32,220, and the highest 10 percent earned more than $57,580. In general medical and surgical hospitals, median annual earnings of respiratory therapists were $43,140 in May 2004.

Median annual earnings of respiratory therapy technicians were $36,740 in May 2004. The middle 50 percent earned between $30,490 and $43,830. The lowest 10 percent earned less than $24,640, and the highest 10 percent earned more than $52,280. Median annual earnings of respiratory therapy technicians employed in general medical and surgical hospitals were $36,990 in May 2004.

Under the supervision of a physician, respiratory therapists administer respiratory care and life support to patients with heart and lung difficulties. Other workers who care for, treat, or train people to improve their physical condition include registered nurses, occupational therapists, physical therapists, and radiation therapists.

Information concerning a career in respiratory care is available from:

• American Association for Respiratory Care, 9425 N. MacArthur Blvd., Suite 100, Irving, TX 75063-4706. Internet: http://www.aarc.org/

For a list of accredited educational programs for respiratory care practitioners, contact either of the following organizations:

• Commission on Accreditation for Allied Health Education Programs, 35 East Wacker Dr., Suite 1970., Chicago, IL 60601. Internet: http://www.caahep.org/

Information on gaining credentials in respiratory care and a list of State licensing agencies can be obtained from:

• National Board for Respiratory Care, Inc., 8310 Nieman Rd., Lenexa, KS 66214-1579. Internet: http://www.nbrc.org/

• Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition,