What Does a Respiratory Therapist Do? An RRT Explains the Full Scope
What Does a Respiratory Therapist Do? An RRT Explains the Full Scope
Most people have heard of respiratory therapists. Far fewer know what we actually do — and the gap between the public perception and the clinical reality is significant. We're not nurses. We're not pulmonologists. We're a distinct licensed clinical profession with a specific scope of practice centered entirely on the cardiopulmonary system, and in many healthcare settings, we are the most specialized clinician in the room when it comes to breathing.
I'm Yashil Bhatt, a licensed Registered Respiratory Therapist with ICU and critical care experience, and the owner of My Respiratory Company. This is the complete answer to what respiratory therapists do — in hospitals, in home care, and in private practice.
What Is a Respiratory Therapist?
A Respiratory Therapist (RT) is a licensed allied health professional who specializes in the evaluation, treatment, and management of patients with cardiopulmonary disorders. The credential hierarchy in the United States is:
- CRT — Certified Respiratory Therapist: Entry-level credential requiring an accredited associate's degree program and passing the Therapist Multiple-Choice (TMC) exam at the entry-level cut score.
- RRT — Registered Respiratory Therapist: The advanced credential, requiring the TMC exam at the advanced cut score plus passing the Clinical Simulation Exam (CSE). The RRT is the standard of practice expected in most ICU, critical care, and specialist settings.
State licensure is required to practice in most states. Continuing education is mandatory to maintain licensure. Specialty credentials exist for neonatal/pediatric care (RRT-NPS), sleep disorders (RRT-SDS), pulmonary function testing (CPFT/RPFT), and adult critical care (ACCS).
Respiratory therapists are not nurses, though we work closely alongside them. Nursing scope of practice covers holistic patient care across all body systems. RT scope is deep and specialized — we focus almost exclusively on the respiratory and cardiovascular systems, with a level of technical expertise in airway management, mechanical ventilation, and pulmonary diagnostics that most other clinicians defer to us on.
What Respiratory Therapists Do in the Hospital
Mechanical Ventilation Management
This is the core ICU function of a respiratory therapist, and it is where the RRT credential earns its reputation. Mechanical ventilation — life support for patients who cannot breathe adequately on their own — is extraordinarily complex. The wrong ventilator settings can cause ventilator-induced lung injury, barotrauma, oxygen toxicity, and hemodynamic compromise. The right settings, titrated correctly over time, can be the difference between survival and death.
Respiratory therapists manage:
- Ventilator mode selection (volume control, pressure control, SIMV, PRVC, APRV, HFOV)
- Tidal volume, respiratory rate, PEEP, FiO₂, I:E ratio, and flow settings
- Lung-protective ventilation protocols (6 mL/kg IBW tidal volumes in ARDS)
- Weaning assessments and extubation readiness evaluation
- Spontaneous breathing trials (SBTs)
- Non-invasive ventilation (BiPAP, CPAP, high-flow nasal cannula) as step-down or step-up therapy
Airway Management
Respiratory therapists are airway specialists. In most hospital systems, we are primary responders for airway emergencies. Our airway management scope includes:
- Endotracheal intubation (in many states and institutions)
- Tracheostomy care and management
- Suctioning — nasotracheal, oropharyngeal, and inline (ventilated patients)
- Cuff pressure management
- Emergency airway response and code participation
- Difficult airway management coordination
Bronchodilator and Respiratory Medication Administration
All inhaled medication administration in most hospital settings goes through respiratory therapy. This includes:
- Nebulized bronchodilators (albuterol, ipratropium, levalbuterol)
- Inhaled corticosteroids
- Mucolytics (acetylcysteine, hypertonic saline, dornase alfa)
- Inhaled antibiotics
- Heliox therapy for severe upper airway obstruction
- Nitric oxide therapy in neonatal and ARDS patients
Pulmonary Diagnostics
Respiratory therapists perform and interpret a range of diagnostic tests:
- Pulmonary Function Testing (PFTs) — spirometry, lung volumes, diffusion capacity (DLCO). The cornerstone of COPD and asthma diagnosis and staging.
- Arterial Blood Gas (ABG) analysis — sampling arterial blood to measure PaO₂, PaCO₂, pH, bicarbonate, and base excess. The definitive respiratory assessment tool.
- Bronchoscopy assistance — airway visualization and specimen collection procedures
- Sleep studies — in sleep labs, RTs with SDS credentials perform and score polysomnography studies
- Exercise testing — 6-minute walk tests, cardiopulmonary exercise testing (CPET)
Airway Clearance Therapy
Patients who cannot clear their own secretions — from neuromuscular disease, post-surgical status, thick secretions in cystic fibrosis or bronchiectasis — require active airway clearance interventions:
- Chest physiotherapy (CPT) — percussion and vibration techniques
- High-frequency chest wall oscillation (Vest therapy)
- Intrapulmonary percussive ventilation (IPV)
- Positive expiratory pressure (PEP) therapy
- Cough assist (mechanical insufflation-exsufflation) devices for neuromuscular patients
Neonatal and Pediatric Respiratory Care
Neonatal ICU (NICU) respiratory therapy is one of the most specialized and technically demanding areas of practice. RTs with neonatal specialty credentials manage:
- Surfactant administration for premature infants with respiratory distress syndrome
- High-frequency oscillatory ventilation (HFOV) for neonates
- Inhaled nitric oxide therapy for persistent pulmonary hypertension of the newborn (PPHN)
- Continuous positive airway pressure (CPAP) for premature lung support
- Transport ventilation during neonatal critical care transfers
What Respiratory Therapists Do in Home Care and Outpatient Settings
CPAP and BiPAP Therapy Management
In home care and DME settings, respiratory therapists are the primary clinical experts for PAP therapy. This includes:
- Reviewing sleep study results and confirming appropriate device selection
- Setting prescribed pressures on CPAP, APAP, and BiPAP devices
- Mask fitting and selection based on face anatomy and sleep position
- Therapy data review — analyzing AHI trends, leak rates, pressure waveforms, and event type distribution
- Troubleshooting compliance barriers — mask leaks, pressure intolerance, humidity issues, mouth breathing
- Coordinating prescription changes with prescribing physicians when therapy data indicates inadequate control
At My Respiratory Company, our $49.99 RT Consultation provides exactly this level of clinical engagement for patients who want their therapy data reviewed by a licensed RRT — not a customer service representative or an automated app.
Home Oxygen Therapy Management
- Oxygen equipment setup and patient education
- Verification that prescribed flow rates maintain target SpO₂
- Assessment of oxygen needs at rest, during exertion, and during sleep
- Equipment troubleshooting and maintenance guidance
- Coordination with physicians for oxygen prescription adjustments as COPD progresses or improves
Pulmonary Rehabilitation
Respiratory therapists are core members of pulmonary rehabilitation teams, delivering supervised exercise training, breathing technique instruction (pursed lip breathing, diaphragmatic breathing, pacing), education on COPD and asthma management, and outcomes measurement for program effectiveness.
Patient and Family Education
A significant portion of RT practice in both hospital and outpatient settings is education — teaching patients and families how to use inhalers correctly, how to operate home oxygen equipment, how to recognize COPD exacerbation warning signs, how to clean and maintain CPAP equipment, and how to integrate breathing exercises into daily life.
Where Respiratory Therapists Work
| Setting | Primary RT Functions |
|---|---|
| Medical ICU / Surgical ICU | Mechanical ventilation, airway management, ABGs, weaning protocols |
| Neonatal ICU (NICU) | Neonatal ventilation, surfactant, HFOV, nitric oxide, CPAP |
| Emergency Department | Airway management, nebulizer therapy, BiPAP/CPAP, intubation support |
| Medical/Surgical floors | Bronchodilator therapy, incentive spirometry, airway clearance, oxygen management |
| Sleep laboratory | Polysomnography, CPAP titration, sleep study scoring |
| Pulmonary function lab | Spirometry, lung volumes, DLCO, bronchodilator response testing |
| Home care / DME | CPAP/BiPAP setup, home oxygen, ventilator management, patient education |
| Outpatient pulmonary clinic | PFTs, inhaler education, COPD management support, smoking cessation |
| Pulmonary rehabilitation | Exercise training, breathing technique, education, outcomes measurement |
| Private practice / telehealth | CPAP therapy management, respiratory consultations, equipment guidance |
How Respiratory Therapists Differ from Pulmonologists
This is a common point of confusion. A pulmonologist is a physician — a medical doctor who completed medical school, internal medicine residency, and pulmonary/critical care fellowship. They diagnose disease, prescribe medications, order procedures, and manage complex cases at the physician level.
A respiratory therapist is not a physician and does not diagnose or prescribe. What we bring is hands-on technical expertise in the delivery and management of respiratory therapy — the equipment, the techniques, the monitoring, and the day-to-day implementation of what the physician has ordered. In the ICU, the pulmonologist sets the treatment plan; the respiratory therapist manages the ventilator, interprets the blood gases, and executes the plan at the bedside around the clock.
In the home care context, a respiratory therapist is the clinical resource for patients managing chronic respiratory conditions between physician visits — the practitioner who knows your CPAP data, your oxygen equipment, your breathing technique, and your day-to-day therapy challenges in detail.
Why the RRT Credential Matters When Buying Respiratory Equipment
When you purchase a CPAP machine, a portable oxygen concentrator, or a nebulizer from a standard retailer or online marketplace, you get a box. When you purchase from a licensed DME supplier with an RRT on staff, you get clinical guidance — device selection matched to your prescription, pressure settings configured correctly, therapy data monitoring, and a resource when problems arise.
That's the difference My Respiratory Company is built on. Every product recommendation, every therapy consultation, every piece of content on this site comes from licensed Registered Respiratory Therapist expertise — not a sales script.
Frequently Asked Questions
How long does it take to become a respiratory therapist?
The minimum pathway is an accredited associate's degree program — typically 2 years — followed by passing the TMC exam to earn the CRT credential. The RRT requires passing the TMC at the advanced cut score plus the Clinical Simulation Exam. Many RTs pursue a bachelor's degree (4 years) for broader clinical and career opportunities. Specialty credentials require additional examination after meeting experience requirements.
Can a respiratory therapist write prescriptions?
No. Respiratory therapists are not prescribers. We operate under physician orders and protocols. In some states and institutions, RTs have protocol-driven authority to make specific therapy adjustments (ventilator settings, oxygen titration) without waiting for an individual physician order for each change — but this is within a physician-approved protocol framework, not independent prescribing authority.
What is the difference between a respiratory therapist and a respiratory nurse?
A respiratory nurse is a registered nurse with specialized experience or certification in pulmonary nursing. They bring nursing's holistic patient care scope to respiratory patients. A respiratory therapist is a separate profession with a fundamentally different educational foundation and scope — specifically trained in ventilator management, pulmonary diagnostics, and the technical administration of respiratory therapy in ways that nursing training does not cover.
Do I need a referral to see a respiratory therapist?
In a hospital setting, RT services are ordered by your physician as part of your care plan. In outpatient and private practice settings like My Respiratory Company, you can access an RT consultation directly without a physician referral. Our $49.99 RT Consultation is available to any patient who wants clinical guidance on their CPAP therapy, home oxygen management, or respiratory equipment questions.
Can a respiratory therapist help me if I'm having trouble with my CPAP machine?
Absolutely — this is a core RT competency. CPAP therapy troubleshooting requires understanding your sleep study data, your machine's therapy data (AHI, leak rate, pressure waveforms), your mask fit, your humidity settings, and your compliance patterns. An RRT can review all of this and give you targeted, clinically grounded recommendations that an automated app or a customer service representative cannot provide. See our CPAP compliance guide and our full range of CPAP troubleshooting articles for a sense of the depth of clinical guidance we bring to these questions.
The Bottom Line
Respiratory therapists are specialized cardiopulmonary clinicians who manage some of the most technically complex and life-critical interventions in medicine — from ventilating premature infants in the NICU to managing ARDS in the ICU to helping a COPD patient optimize their home oxygen therapy. The scope is broad, the technical depth is significant, and the credential — particularly the RRT — represents a genuine standard of clinical expertise.
When you work with My Respiratory Company, you're working with that expertise directly. Browse our respiratory equipment catalog — CPAP machines, oxygen concentrators, nebulizers, pulse oximeters — or book a direct $49.99 Respiratory Therapist Consultation to get clinical guidance on your specific therapy needs. Have equipment to trade in? Our DME buyback program is here for that too.
Written by Yashil Bhatt, RRT — Licensed Registered Respiratory Therapist with ICU and critical care experience and owner of My Respiratory Company.