Respiratory therapy is a healthcare specialty focused on diagnosing, treating, and managing conditions that affect breathing and the cardiopulmonary system. Respiratory therapists (RTs) work with patients who have trouble getting enough oxygen, from premature infants with underdeveloped lungs to adults on life support in the ICU. The field spans emergency rooms, hospital floors, sleep labs, pulmonary rehab centers, and home care settings.
What Respiratory Therapists Do
At its core, respiratory therapy involves keeping people breathing. That can mean something as routine as teaching an asthma patient how to use an inhaler, or as high-stakes as managing a ventilator for someone in respiratory failure. RTs perform diagnostic and therapeutic interventions for patients with cardiopulmonary disease, working under or alongside physicians to assess, treat, and monitor breathing problems.
Day-to-day responsibilities include delivering aerosolized medications (breathing treatments), drawing arterial blood samples to measure oxygen and carbon dioxide levels, setting up and adjusting oxygen delivery systems, and performing airway clearance techniques for patients who can’t effectively cough or clear mucus on their own. RTs also run pulmonary function tests, which measure how well your lungs move air in and out. These tests are essential for diagnosing conditions like COPD and asthma and for tracking how well treatments are working.
Equipment RTs Manage
Respiratory therapists are the go-to professionals for the machines that support breathing. The most critical is the mechanical ventilator, which controls or assists a patient’s breathing while delivering a set amount of oxygen. Ventilators are used in intensive care units for patients who can’t breathe on their own due to illness, injury, or surgery.
Outside the ICU, RTs work extensively with CPAP and BiPAP machines. A CPAP machine delivers a continuous stream of air pressure through a mask to keep the airway open, most commonly prescribed for obstructive sleep apnea. A BiPAP machine works similarly but uses higher pressure when you breathe in and lower pressure when you breathe out, making it easier to exhale. RTs also manage high-flow oxygen systems, nebulizers, and other devices that deliver medications or supplemental oxygen to the lungs.
Conditions Treated
Respiratory therapists treat a wide range of conditions across all age groups:
- COPD, the progressive lung disease most often caused by smoking, which requires ongoing oxygen therapy, medication delivery, and pulmonary rehabilitation
- Asthma, where RTs help manage acute attacks and educate patients on long-term control
- Cystic fibrosis, a genetic condition that causes thick mucus buildup in the lungs, requiring daily airway clearance therapy
- Acute respiratory distress syndrome (ARDS), a life-threatening condition where fluid fills the lungs, often requiring mechanical ventilation
- Pneumonia, where oxygen support and breathing treatments help patients recover
- Sleep apnea, managed through CPAP or BiPAP therapy
- Respiratory failure, which can result from many causes and often requires intensive ventilator management
RTs also care for newborns with respiratory distress syndrome, a common complication in premature babies whose lungs haven’t fully developed.
Lung Function Testing
One of the more technical sides of respiratory therapy is pulmonary function testing. The most common test is spirometry, which measures two key values: how much air you can forcefully exhale (forced vital capacity, or FVC) and how much of that air comes out in the first second (FEV1). The ratio between these two numbers helps determine whether a breathing problem is obstructive or restrictive.
An FEV1/FVC ratio below 0.70 indicates an obstructive defect, meaning air has trouble getting out of the lungs. This is characteristic of COPD and asthma. A total lung capacity below 80% of the predicted value points to a restrictive defect, where the lungs can’t fully expand. This pattern shows up in conditions like pulmonary fibrosis. Both FEV1 and FVC above 80% of predicted, with a ratio above 0.70, is considered normal. RTs administer these tests, ensure proper technique, and help interpret the results.
The Role in Emergencies
Respiratory therapists are essential members of emergency response teams. During cardiac arrests, strokes, and trauma responses, RTs handle airway assessment, stabilization, intubation (placing a breathing tube), and ongoing airway management. They respond to rapid response calls alongside nurses and physicians, and their expertise in managing the airway is often the most critical factor in the first minutes of an emergency.
In emergency departments, RTs assess patients in respiratory distress, initiate breathing treatments, and make decisions about the type and level of oxygen support needed. Their ability to quickly evaluate whether a patient needs a simple oxygen mask versus a ventilator can be the difference between stabilization and deterioration.
Education and Credentials
Becoming a respiratory therapist requires at minimum an associate degree from a program accredited by the Commission on Accreditation for Respiratory Care (CoARC). Graduates must be at least 18 years old and pass the Therapist Multiple-Choice (TMC) Examination administered by the National Board for Respiratory Care (NBRC).
The TMC exam has two scoring thresholds. Reaching the lower cut score earns the Certified Respiratory Therapist (CRT) credential. Reaching the higher cut score earns the CRT and makes you eligible for the Clinical Simulation Examination, which leads to the Registered Respiratory Therapist (RRT) credential. The RRT is the more advanced designation and is increasingly the standard employers expect. Many programs now offer bachelor’s degrees, and some RTs pursue advanced practice roles that include responsibilities like prescribing medications and diagnosing cardiopulmonary conditions under physician supervision.
Job Outlook and Pay
Respiratory therapy is a growing field. The median annual wage was $80,450 as of May 2024, according to the Bureau of Labor Statistics. Employment is projected to grow 12% from 2024 to 2034, which is significantly faster than the average for all occupations. An aging population with higher rates of chronic lung disease, along with continued demand in critical care, drives that growth.
RTs work in hospitals, outpatient clinics, long-term care facilities, sleep disorder centers, and patients’ homes. Hospital-based positions, particularly in intensive care, tend to involve shift work including nights and weekends. Home care and outpatient roles typically follow more regular schedules.