Respiratory therapists—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. They consult with physicians and other healthcare staff to help develop and modify patient care plans. Therapists also provide complex therapy requiring considerable independent judgment, such as caring for patients on life support in intensive-care units of hospitals.
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. They provide temporary relief to patients with chronic asthma or emphysema and give emergency care to patients who are victims of a heart attack, stroke, drowning, or shock.
Respiratory therapists interview patients, perform limited physical examinations, and conduct diagnostic tests. For example, respiratory therapists test a patient's breathing capacity and determine the concentration of oxygen and other gases in a patient's blood. They also measure a patient's 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 blood pH levels, therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician, who then makes treatment decisions.
To treat patients, respiratory therapists use oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications—liquid medications suspended in a gas that forms a mist which is inhaled. They teach patients how to inhale the aerosol properly to ensure its effectiveness. 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 setting 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 a 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.
Respiratory therapists perform chest physiotherapy on patients to remove mucus from their lungs and make it easier for them to breathe. Therapists place patients in positions that help drain mucus, and then vibrate the patients' rib cages, often by tapping on the chest, and tell the patients to cough. Chest physiotherapy may be needed after surgery, for example, because anesthesia depresses respiration. As a result, 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 who work in home care teach patients and their families to use ventilators and other life-support systems. In addition, these therapists visit patients in their homes to inspect and clean equipment, evaluate the home environment, and ensure that patients have sufficient knowledge of their diseases and the proper use of their medications and equipment. Therapists also make emergency visits if equipment problems arise.
In some hospitals, therapists perform tasks that fall outside their traditional role. Therapists are becoming involved in 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.
Work Environment
Respiratory therapists held about 135,100 jobs in 2020. The largest employers of respiratory therapists were as follows:
- Hospitals; state, local, and private - 82%
- Nursing care facilities (skilled nursing facilities) - 4%
- Offices of physicians - 2%
Respiratory therapists work in various areas of a hospital, including emergency rooms, critical care units, and neonatal intensive care units.
Respiratory therapists may stand for long periods and may need to lift or turn patients.
Injuries and Illnesses
Like other healthcare workers, respiratory therapists may be exposed to patients who have infectious diseases. They also may experience strains or sprains when lifting or turning patients. Because of this, they must take precautions to minimize their risk of illness or injury.
Work Schedules
Most respiratory therapists work full time. Because they may work in medical facilities that are always open, such as hospitals, they may have shifts that include nights, weekends, or holidays.
Education & Training Required
An associate degree is required to become a respiratory therapist. Training is offered at the postsecondary level by colleges and universities, medical schools, vocational-technical institutes, and the Armed Forces. Most radiation therapy programs award associate or bachelor's degree Scholarships and prepare graduates for jobs as advanced respiratory therapists. A limited number of associate degree programs lead to jobs as entry-level respiratory therapists. According to the Commission on Accreditation of Allied Health Education Programs (CAAHEP), 31 entry-level and 346 advanced respiratory therapy programs were accredited in the United States in 2008.
Among the areas of study in respiratory therapy programs 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.
High school students interested in applying to respiratory therapy programs 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.
Certifications Needed
A license is required to practice as a respiratory therapist, except in Alaska and Hawaii. Also, most employers require respiratory therapists to maintain a cardiopulmonary resuscitation (CPR) certification.
Licensure is usually based, in large part, on meeting the requirements for certification from the National Board for Respiratory Care (NBRC). The board offers the Certified Respiratory Therapist (CRT) credential to those who graduate from entry-level or advanced programs accredited by CAAHEP or the Committee on Accreditation for Respiratory Care (CoARC) and who also pass an exam.
The board also awards the Registered Respiratory Therapist (RRT) to CRTs who have graduated from advanced programs and pass two separate examinations. Supervisory positions and intensive-care specialties usually require the RRT.
Other Skills Required
Therapists should be sensitive to a patient's 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.
How to Advance
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 a bachelor's or master's degree, also may advance to supervisory or managerial positions in a respiratory therapy department. Respiratory therapists in home healthcare and equipment rental firms may become branch managers. Some respiratory therapists advance by moving into teaching positions. Some others use the knowledge gained as a respiratory therapist to work in another industry, such as developing, marketing, or selling pharmaceuticals and medical devices.
Job Outlook
Employment of respiratory therapists is projected to grow 23 percent from 2020 to 2030, much faster than the average for all occupations.
About 10,100 openings for respiratory therapists are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
Employment
Growth in the middle-aged and older population will lead to an increased incidence of respiratory conditions such as pneumonia, chronic obstructive pulmonary disease (COPD), and other disorders that can permanently damage the lungs or restrict lung function. The aging population will in turn lead to an increased demand for respiratory therapy services and treatments, mostly in hospitals.
In addition, a growing emphasis on reducing readmissions in hospitals may result in more demand for respiratory therapists in nursing homes and in doctors’ offices.
Advances in preventing and detecting disease, improved medications, and more sophisticated treatments will also increase the demand for respiratory therapists. Other conditions affecting the general population, such as respiratory problems due to smoking and air pollution, along with respiratory emergencies, will continue to create demand for respiratory therapists.
Earnings
The median annual wage for respiratory therapists was $61,830 in May 2021. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $47,380, and the highest 10 percent earned more than $95,540.
In May 2021, the median annual wages for respiratory therapists in the top industries in which they worked were as follows:
- Hospitals; state, local, and private - $61,940
- Offices of physicians - $60,570
- Nursing care facilities (skilled nursing facilities) - $60,570
Most respiratory therapists work full time. Because they may work in medical facilities that are always open, such as hospitals, they may have shifts that include nights, weekends, or holidays.
