The need for respiratory therapists is greater than ever and their roles are expanding into new areas.

Respiratory Care Week

Q&A: The Changing Landscape for Respiratory Care

"All systems evolve based on what the patients need. As we learn more on the scientific and clinical sides, we need to expand our scope of practice, clinical decision making, and our value to our patients. "

Incorporating all that has been learned from the global pandemic, the roles of respiratory therapists are shifting to take on more responsibility for prevention.

Respiratory Therapists (RTs) — whose patients range from newborns to the elderly — can play an integral role helping patients manage their own chronic lung diseases. That preventative work helps avoid hospital visits and improves quality of life, says Sam Giordano, who is interim executive director of the American Association for Respiratory Care (AARC), based in Irving, Texas, and who previously served as president and, for more than 30 years, was its executive director and chief executive.

The AARC is a professional association which advocates for patients with lung diseases and the respiratory therapists who serve them. Each year AARC highlights respiratory therapists during Respiratory Care Week, which ran from Oct. 24-30. As the global pandemic stretches into a second year, there is more reason than ever to spotlight the resiliency and optimism of respiratory therapists — and their power to make a difference.

This is the second part of a two-part conversation with Giordano as he offers a glimpse into the future of respiratory care.

SUE: What changes are going on in the field these days?

Giordano: We are making a huge difference in critical care. RTs are the tip of the spear regarding managing complex patients requiring mechanical ventilation. However, we haven’t done nearly enough in helping the millions of people with chronic pulmonary diseases.

We can empower these patients to take better care of themselves while monitoring their ability and effectiveness in doing so. Even if you have a chronic disease, you can live with it and you can manage it if you have the knowledge and the tools. If we don’t teach our chronic disease population to manage their disease, we’re never going to get a handle on healthcare costs in this country, which continue to rise.

SUE: The role of RTs appears to be expanding — taking on more duties at the bedside, doing more education, navigation, and disease management. Why, and what do you think about this?

Giordano: Part of the post-COVID plan is to get RTs out there to give the full array of vaccinations, including flu, pneumonia, and others. Their licenses already allow them to do it. Throughout the pandemic, RTs stepped up and provided COVID vaccinations and still do. I think we should build on it and not let go of it and improve our value to patients and physician employers.

We could do so much for patients if we were allowed to interface with them at the physician practice level. We could eliminate a lot of exacerbations and improve their quality of life. It’s much better from a human standpoint, and expense standpoint, to prevent a flareup in a chronic disease. But it would take doctors knowing that the service provided by an RT, in their employ, can be billed to Medicare and Medicaid and private insurers. We must fix this.

SUE: How important do you see the new role of COPD navigators?

Giordano: It’s indispensable for the management of the disease. However, I would call it "chronic lung disease management" since we can help others with chronic pulmonary diseases. There are people who are so out of breath they’re afraid to get out of a chair. We could help them if we could have RTs go out to their home and assess their needs on behalf of their attending physician.

It is interesting to note that of all the patients with chronic lung diseases that can benefit, less than 5 percent are referred to pulmonary rehabilitation programs. A compounding factor is even if a patient is referred, many do not have a pulmonary rehab facility in their area.

We need to rebuild the  pulmonary rehab infrastructure for these patients. They’ll live longer and consume fewer healthcare resources. At this time, reimbursement is so low hospitals or other providers won’t start these programs because they are unable to sustain them from a business standpoint. Diagnosing lung disease remains a problem. For example, did you know that about 30 percent of people with COPD never smoked? There are 15 million diagnosed with COPD and probably another 15 million not diagnosed who don’t know they have a lung disease

SUE: What kinds of technological changes are impacting the field?

Giordano: Ventilators continue to be more sophisticated. They help us tailor the ventilator to the patient’s needs. There are advancements in supplemental oxygen, especially for home use. We can now move many hypoxic patients from oxygen tanks that can weigh 20+ pounds to oxygen concentrators that weigh less.

This can give patients an enormous amount of freedom to move and mainstream with society. That results in an improved health status and quality of life.

SUE: Many facilities are looking for RTs with bachelor’s rather than associate degrees. What are your thoughts on this?

Giordano: All systems evolve based on what the patients need. As we learn more on the scientific and clinical sides, we need to expand our scope of practice, clinical decision making, and our value to our patients. Many RTs do more than just provide the care. They also assess the effectiveness of the intervention and recommend changes.  

It’s important for us to go beyond rendering care by adding the role of utilization gatekeepers, while considering any comorbidities the patient may have. That requires more education. Our current RTs are lifelong learners, but going into the future we, as well as other professions, will revise and enhance our formal education curricula to accommodate expanding roles previously mentioned.

We have to have somebody at the bedside who can say, “They don’t need this” or “We could do this.”  These require more than a procedure-specific or range of procedures-specific knowledge. There is critical thinking, and assessment which must play a more prominent role if we are to find a balance between healthcare cost while meeting the needs of our patients.

Click here to read Part 1 of the Q&A with Sam Giordano.

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