Respiratory care is the management and treatment of breathing disorders through individualized treatment plans for patients with disorders affecting breathing. It is a critical part of lifesaving responses for patients with medical emergencies and also an important aspect of medical care in many acute or chronic cardiopulmonary conditions including asthma, bronchitis, pneumonia, heart and lung disease, traumatic accidents, and mechanical ventilation for life support.
Respiratory care supports the overall health and wellness of the cardiorespiratory or cardiopulmonary system using appropriate equipment and devices to evaluate, diagnose, monitor, treat, prevent, and manage respiratory diseases.
Respiratory care often starts with patient assessment and an individualized respiratory care plan that include diagnostic testing, monitoring, education, rehabilitation, and goals. Depending on the complexity of care needed, respiratory care can be self-administered, or done by caregivers and specialized clinical staff such as respiratory therapists or respiratory care practitioners, and can be provided in skilled nursing centers, home health agencies, specialty care hospitals, physicians offices, and many other medical settings.
According to the American Association for Respiratory Care (AARC), “knowledge and understanding of the scientific principles underlying cardiopulmonary physiology and pathophysiology, as well as biomedical engineering and application of technology, enables respiratory therapists to provide direct and indirect patient care services efficiently and effectively across all care settings.”
Due to the complexities of respiratory care, respiratory care often involves a multidiscplinary team approach that includes respiratory therapists, doctors, nurses, social workers, pharmacists, psychologists, physical therapists, occupational therapists, dieticians, ancillary medical staff, patients, and caregivers.
Goals of Respiratory Care
The major goal of respiratory care is to ensure breathing at the highest level of performance using appropriate respiratory care devices and equipment. A respiratory care specialist or therapist often Collaborates with other clinicians with a common goal of normalizing or stabilizing breathing using a variety of approaches including pulmonary rehabilitation for better long-term outcome.
Who is a Respiratory Care Patient?
Respiratory care patients are those who need assistance with breathing, acutely or chronically, including patients with:
- Asthma – a condition where a patients airways narrow and swell and produce extra mucus that can often lead to shortness of breath and difficulty breathing.
- Acute Respiratory Distress Syndrome – which occurs after an injury or serious illness like COVID-19. Respiratory care is an important part of recovery for COVID-19 patients who require respiratory therapy.
- Lung surgery – most lung surgery patients need pre-op respiratory care for preparing for surgery as well as post-surgery respiratory care during recovery.
- COPD (chronic obstructive pulmonary disease) – patients with COPD including emphysema or chronic bronchitis have partially blocked airways and that makes it difficult to breathe in and out without respiratory care.
- Cystic fibrosis – an inherited disease that causes sticky mucus to collect in lungs and block the airways making it difficult to get air in and out.
- Muscular Dystrophy – a muscle-wasting disorder that affects the muscles used for breathing, thus leading to chronic breathing problems.
- Interstitial lung disease – a disorder such as pulmonary fibrosis and sarcoidosis which causes lung scarring over a period of time making it hard to get oxygen into the airways.
- Sleep Apnea – a serious sleep disorder in which breathing repeatedly stops and starts while asleep. Sleep apnea has many medical consequences.
- Parkinson's disease – some patients with Parkinson's disease experience varied respiratory symptoms including shortness of breath and obstructive sleep apnea.
- Trauma – these include auto accidents and other traumatic events that compromise breathing function.
- Preterm babies – babies who are born prior to their lungs being fully developed often need respiratory care to thrive.
- Other medical conditions with compromised breathing including tuberculosis and pneumonia.
Types of Respiratory Care/Therapy
Emergency respiratory care – this is done mostly in the hospital and in urgent situations, and sometimes involves complicated surgeries, use of ventilators, managing life support, using a variety of respiratory care products, and managing medically complex situations like lung failure or heart surgery.
Adult respiratory care – this can happen at home, the hospital, or various outpatient clinics. Adult respiratory care involves routine care and maintenance of chronic diseases like cystic fibrosis and emphysema. Adult respiratory care can involve post-surgical and post-trauma pulmonary rehabilitation as well as routine diagnosis of sleep apnea in a sleep lab. Adult respiratory care products vary but include devices like non-rebreather masks and partiial rebreather oxygen masks.
Geriatric respiratory care – our lung ages along with the rest of our body, predisposing the elderly to more respiratory diseases and infections including COPD and respiratory tract infections. Some of these respiratory conditions require breathing assistance or respiratory devices like an aerosol mask. Geriatric respiratory care can occur at home, a hospital, or an outpatient setting.
Pediatric respiratory care – pediatric respiratory care focuses on respiratory conditions in newborns and children and can be used for acute or chronic cases. Most respiratory care for acute cases in newborns occurs in the hospital neonatal units while chronic and less urgent conditions like asthma, where nebulizers may be used, happen at home or in outpatient clinics.
Types of Respiratory Care Products
Respiratory devices are the mainstay for diagnosing, monitoring, and treating of respiratory diseases. They are used in many environments including the home, emergency rooms, intensive care units, neonatal units, and outpatient clinics. These devices, along with a good treatment plan from a healthcare provider, help to improve the overall quality of life for patients with acute and chronic respiratory diseases. Some respiratory care products include:
- Nebulizers are small machines that turn liquid medicine into mist. Patients typically breathe in the medicine through a mouthpiece (aerosol mask connected to a tubing). Nebulizer treatments are effective for preventing a worsening of breathing problems and are useful for treating acute breathing emergencies. Nebulizers come in many shapes and sizes including:
- Nebulizers –
- Portable pediatric nebulizers – designed for comfort and ease of use in pediatric patients. This kid-friendly nebulizer is small, compact, and lightweight. It includes a disposable mouthpiece as well as other reusable accessories.
- Mini travel nebulizer – most patients who are on nebulizer treatments still require their medications while traveling. A mini travel nebulizer, especially one with a rechargeable battery, allows patients the flexibility of traveling with medication, thus increasing adherence. Mini travel nebulizers typically come with disposable mouthpiece, adult mask, and pediatric mask for ease of use.
- Portable compact nebulizer – nebulizers like a compact nebulizer with rechargeable battery is perfect as an on-the-go nebulizer. This nebulizer is complete with the medication, disposable mouthpiece, adult mask, and pediatric mask. It is discrete and fits in the palm of your hand. Just like the mini travel nebulizer, the portable compact nebulizer is useful for travel, daily use, and at-home treatment. The rechargeable battery makes it perfect for cordless use.
- Portable nebulizer compressor – studies show that compliance with respiratory care increases in patients who have more access to their respiratory devices. For patients on nebulizers like asthma patients, portable and discreet nebulizers can ensure adherence to a medication routine since they can use the nebulizer wherever they are. The Sunset heandheld ergonomic portable nebulizer compressor is small, weighs just about ½ pound, has a compressor, medication cup, mouth piece, mask, batteries, air hose, AC power adaptor, and can be used by patients of all ages.
- Masks – a good mask mimics and supports natural breathing. Some therapeutic masks include:
- The patrial rebreather oxygen mask is available in pediatric and adult sizes and is perfect for administering oxygen in high concentration at up to 15 L per minute.
- The non- rebreather oxygen mask is designed to start the flow of oxygen faster especially in patients with low blood oxygen levels. This mask prevents rebreathing, thus allowing exhaled gas to escape. A non-rebreather oxygen mask can supply about 10 L of oxygen per minute.
- Tracheostomy masks, like the latex-free pediatric and adult tracheostomy mask with a removal adapter that attaches to the aerosol or oxygen supply tubing, allow for the delivery of supplemental oxygen therapy to patients who have undergone a tracheostomy. These masks are typically placed around the trach stoma and comfortably fitted around the neck, often allowing a 360-degree swivel in two places for ease of use.
- Aerosol masks are designed to be used for administering high-flow oxygen, humidity, or a nebulized solution to patients. A comfortable aerosol mask should be soft and flexible and should form a gentle seal on the skin while covering the nose and mouth. Most aerosol masks have a nose clip and elastic head strap for a more comfortable fit.
- simple oxygen masks increase oxygen flow. They are also flexible, gentle on the skin, and designed to fit with a secure and comfortable seal around a patient’s head. Simple oxygen masks can supply 5-12 L of oxygen per minute.
- Positive Air Pressure (PAP) devices – PAP devices, also known as continuous positive airway pressure therapy (CPAP) devices, are used for the treatment for obstructive sleep apnea (OSA). Sleep apnea is a commonly undiagnosed disease linked to cardiovascular disease, daytime sleepiness, mental fog, snoring, reduced concentration, stroke, and decreased emotional stability. CPAP therapy keeps the airways open by delivering constant steady air pressure through a mask while a patient is asleep. This reduces snoring, improves oxygen flow, and reduces the symptoms of sleep apnea.
- CPAP Cleaner – this is a convenient and hygienic home device for cleaning CPAP equipment including the mask, tube, and machine.
- Humidifiers – these add moisture to the air to prevent dryness and irritation, thus making breathing easier.
- Inhalers – inhalers are devices that hold medication that you breathe in. Different types of inhalers include dry powder inhalers (DPIs), soft mist inhalers (SMIs), and metered-dose inhalers (MDIs.) Inhalers are often used with inhalation chambers.
- Inhalation chamber and spacers for metered-dose inhalers – these are devices attached to a mouthpiece of an inhaler to help create a space for the medicine to break down into smaller droplets. When broken down, these droplets move more efficiently and can reach deeper into the lungs where it is needed. A valved holding inhalation chamber, like the speracha,ber, is an advanced spacer that not only breaks medicine down, but also creates an airtight seal that traps the medicine within that space, allowing patients time to take slow deep breaths of the medication. This medicine then goes past the mouth and throat and into the lungs. According to the American Lung Association, spacers make it easier to avoid breathing medicine too fast. Spacers also reduce the risk of spraying medicine and breathing at the same time since that can reduce the effectiveness of the medicine. Pediatric- sized spacers designed specifically for young patients relieve the anxiety of taking medication and improve the effectiveness of metered-dose inhalers.
- Other respiratory care devices include nitric oxide delivery units for nitric oxide therapy; capnographs for monitoring the partial pressure of carbon dioxide in an exhaled breath as well as monitoring airways in both intubated and non-intubated patients.; reusable resuscitators for providing breathing assistance by inflating the lungs of an unconscious patient who is not breathing; oxygen hoods for babies who need supplemental oxygen; oxygen concentrators for patients who need long-term oxygen at home; ventilators for providing mechanical ventilation to patients who are unable to breathe sufficiently on their own.
- Pulse oximeters – also known as Pulse Ox, these are reusable or disposable electronic devices that measure the saturation of oxygen in a patient’s red blood cells. They can be attached to various parts of the body including the ears, toes, fingers, forehead, nose, and feet. Pulse oximeters help to determine when a patient might need supplemental oxygen as part of respiratory care. A good saturation number is 90% and above. According to the American Lung Association, pulse oximeters are simple, quick, and safe and provide a readout of the heart rate and oxygen saturation within a few seconds, making it a good tool for respiratory care at home and in other clinical settings.. Various types of pulse ox devices include
- Table-top oximeter
- Bedside oximeter
- Handheld oximeter
- Fingertip pulse oximeter
- Wrist-worn pulse oximeter
- Pediatric pulse oximeter
- Peak flow meters – these are diagnostic tools typically used by asthma patients to measure exhalation. Peak flow meter measurements can alert a patient on worsening asthma as well as aid a healthcare provider in making adjustments to treatment and respiratory care.
- Spirometers – these are diagnostic devices that measure respiration (breathing in and out) and the time it takes for full exhalation after each deep breath. They are used to keep the lungs clear, free of fluid, and active during recovery from a lung illness or surgery. The spirometer has a piston that rises within the device to measure the volume of a patient’s breath. Typically, as part of respiratory care, a healthcare provider sets a target breath volume as part of overall respiratory therapy. Spirometers are also used in pneumonia, chronic obstructive disease, cystic fibrosis and other medical conditions.
- Polysomnography (PSG) Devices – also known as sleep study, polysomnography records breathing, heart rate, oxygen level, eye movement, leg movement, and brain waves as part of a comprehensive sleep study to diagnose sleep disorders and abnormalities including obstructive sleep apnea, chronic insomnia, and narcolepsy.
Consumables and Accessories
- Nasal cannulas – a nasal cannula, like the soft adult cannula, is used to deliver supplemental oxygen directly to a patient in need of increased oxygen. Poorly designed nasal cannulas can be uncomfortable and can impede airflow. A design which is soft, relaxed, and flexible is easier to use by the patient or professional caregiver, and also feels more comfortable. Nasal cannulas with connectors like the soft adult cannula with universal coneector will fit most respiratory oxygen machines and effectively deliver the recommended 1-6 liters of oxygen per minute. A high-quality nasal cannula is not only soft and flexible but should also fit comfortably inside of the nose for direct airflow. Nasal cannulas should have an internal safety check to prevent kinks that can compromise the patient during use.
- Disposable masks – these are face coverings designed to protect the wearer by acting as a physical barrier between the nose and the mouth and contaminants like harmful viruses and bacteria.
- Disposable resuscitators – these are used for lung ventilation to force oxygen into the lungs of a person who is not breathing without the risk of cross-contamination and need for clean-up.
- Tracheostomy tubes – also known as a tach, a tracheostomy tube is typically a curved tube inserted into the tracheostomy stoma which is the hole created in the trachea (wind pipe) and neck to facilitate breathing. Sometimes, the tube is connected to an oxygen supply and a ventilator.
- Nebulizer kits – these are used with nebulizers, and each kit can contain different components including a supply tube, a nebulizer cup, a reservoir tube, a nebulizer bottle, and a T-shaped mouthpiece. Some nebulizer kits contain an angled mouthpiece for increased comfort; medication jar for a leak-proof seal like the disponsable adult nebulizer kit; and a corrugated reservoir tube like the reusable nebulizer kit. Most kits are disposable and easy to clean and reassemble.
Aging and Respiratory Care
The respiratory system inevitably undergoes several structural, physiological, and immunological changes as we age. The lung matures by 20-25 years and thereafter, the lungs progressively decline in function. Some of these normal age-related changes can affect the overall functioning of the respiratory system, thus leading to difficulty in breathing and an overall decline in lung function. This decline is associated with a diminished response to therapy and drugs typically use to treat younger patients, making treatment more challenging.
Pulmonary rehabilitation is useful in managing chronic lung diseases or other conditions that limit daily activities due to difficulty with breathing. It does not replace medical treatments but rather is used in conjunction with other existing therapies to improve patients’ cardiopulmonary symptoms, increase ability to participate in exercise, and improve the overall quality of life.
Pulmonary rehabilitation can be self-directed, like breathing exercises, and can done in the hospital, at home, or in the clinic. According to the National Heart, Lung and Blood Institute, pulmonary rehabilitation is a supervised program that includes exercise training, health education, and breathing techniques for people who have certain chronic lung conditions or lung problems due to other medical conditions. Pulmonary rehabilitation is based on age, other underlying medical conditions, health of lungs, and other considerations.
Pulmonary rehabilitation can improve breathing, improve strength, reduce anxiety and depression, increase ability to manage daily routine, and improve the overall quality of life of patients who have chronic diseases like cystic fibrosis, pulmonary hypertension, asthma, chronic obstructive pulmonary disease (COPD), and other lung-function-limiting conditions. Rehabilitation can also be beneficial to lung transplant or lung cancer patients.
Other Strategies to Improve Breathing
Although respiratory care can include using medical devices and equipment to facilitate breathing, other strategies that also help to improve lung function and overall health include:
- Review of your medical history to create an individualized respiratory care plan
- Mental health assessment to provide the appropriate psychological counseling and support
- Exercise training to improve lung condition, stamina, endurance, and muscle strength
- Breathing strategies to increase oxygen intake, normalized breathing frequency, and to keep airways open for longer periods of time
- Relaxation techinques to reduce anxiety and depression, and improve air flow into the lungs
- Nutritional counseling to achieve optimal weight since being underweight or overweight can affect breathing
- Medications to improve respiratory health outcomes