I am a respiratory therapist. If you don’t know what that is, don’t feel bad – until about a year before I became one, I didn’t know the job even existed. Think of a nurse, but focused and trained intensively and specifically on the heart and lungs. We don’t give narcotics or wipe butts, we give bronchodilators (airway openers) and ask people to hawk up a loogie so we can look at it. Like any job, it’s not all glorious.

Respiratory Therapy is a medical specialty just as nursing, physical therapy, occupational therapy, speech therapy, radiology, and others are medical specialties. We specialize in, you guessed it, the lungs. Actually, the heart and lungs, the cardiopulmonary system, as the two work inextricably together, and when one has problems, the other soon does too. As the body’s organ systems are all closely linked, we need to have a strong understanding of the rest of the body’s anatomy and physiology as well.

A degree in respiratory therapy is usually a two year Associate of Applied Science degree, although there are Bachelor of Science degree respiratory therapy programs. Each program is accredited by The Commission on Accreditation for Respiratory Care (CoARC). The programs generally cover basic biology, chemistry, etc. during the first year, then focus on more specific coursework such as detailed lung and heart anatomy and physiology, pharmacology, pulmonary diseases, ventilator management, pulmonary function testing and interpretation, and arterial blood gases during the second year. There is also a clinical portion of the program where students shadow respiratory therapists (RTs) and gain hands-on experience under supervision. After graduation, respiratory therapists must take an exam to receive their credentials and be able to apply for a state license to practice. The credentials are provided by the National Board for Respiratory Care (NBRC). Once licensed, RTs can join national and state professional organizations like the American Associate for Respiratory Care (AARC). Membership in a professional organization has many benefits including free and discounted continuing education credits, respiratory conference information and discounted registration fees, and the latest information in respiratory care guidelines such as the AARC’s monthly publication Respiratory Care Journal.

Respiratory therapists are capable of performing a wide range of jobs, and there are several “specialty” jobs an RT can have once in the workforce. An RT can work in a hospital setting and care for patients on ventilators, give bronchodilators to asthmatics and sick children with pneumonia or adults with an exacerbation of their COPD, and intubate critically ill patients in the ICU and ER.

An RT can also perform pulmonary function testing (PFT) on patients to determine how well their lungs work, whether or not they have a lung disease such as asthma, COPD, or pulmonary fibrosis, and if inhalers help their lungs.

Some RTs stay up all night and perform sleep studies to see if a person has sleep apnea and needs BiPAP or CPAP at home. Others can work in home care, and, once a person has been shown to need BiPAP, CPAP, or oxygen at home, set up the equipment at patients’ homes, and check in with the patient regularly to be sure every is working well.

Respiratory therapists perform their duties under the direction of a physician medical director. This can be a critical care doctor, pulmonologist, or anesthesiologist. Based on the size and level of care a hospital provides, the medical director will determine which specific functions the respiratory therapists will perform. For example, at the hospital where I work, we draw arterial blood gas (ABG) samples, but we don’t place arterial lines, even though we are legally allowed under our license. This is because my hospital is a teaching hospital, and our medical director would prefer the medical residents place arterial lines for the experience. Studies have shown that therapist-driven protocols – where the RT, as the frontline of patient care, constantly re-evaluates the patient’s status and changes the course of treatment within set guidelines – provide the most efficient patient care and not only reduce the length of hospital stay but also the overall cost of care. Many hospitals have adopted different forms of therapist-driven protocols, to the delight of the RTs working there. Depending on where a therapist works, they will perform different tasks.

Respiratory therapists, like all practitioners of medicine, need to complete a certain number of continuing education credits (CECs) during a certain time period. This is to ensure we stay up-to-date with current scientific data and recommendations in our field. For RTs, 30 credit hours are needed in each biannual period. 10 of these credits need to be “live”, or obtained by directly observing their instruction such as listening to a lecture at a conference. The other 20 credits can be obtained by listening to a pre-recorded webinar or reading an article approved for CECs and taking a test on its content.

Respiratory therapy is an exciting and rewarding career, and the different “specialties” of the profession allow an RT work in the setting best suited to their life, preferences, and abilities. I work in a relatively large hospital with a large average population of patients with respiratory issues, and a busy ICU and ER. This means, I can give a sweet little old lady with COPD her daily “puffer”, and five minutes later be doing CPR on a bloodied motorcycle crash victim who’s clinging to life. Then, when that motorcycle crash victim is recovering in the ICU, I manage the ventilator breathing for him, and eventually take the breathing tube out when he’s well enough to no longer need it. The job is intense, fast-paced, stressful, and highly gratifying. It also has its sad moments. Not every sick or injured patient recovers, and when a patient doesn’t make it, your heart breaks. And when their distraught family members smile through the tears and thank you for everything you did for their family member or friend, your heart breaks again. In this moment though, you also see clearly the compassionate human aspect in us all. It’s these moments of distilled humanity and empathy, where you feel connected to complete strangers, that are the most fulfilling and rewarding parts of the job, and what makes occasionally seeing death easier… seeing life.