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Breathe Easy:

Respiratory Therapists and the Evolution of a Profession

 

STOP! Inhale… 1…2…3… Exhale… 1…2…3… What do you notice? How often do you concentrate on your breathing?

Unless there is an illness or some difficulty, humans tend to take breathing for granted. Yet in the ancient world, understanding that breath was critically necessary for life was among the first discoveries of human physiology.

Since ancient times, inhalation therapies were practiced to treat lung ailments. The first known tracheostomy was depicted on a stone slab in Egypt in 3150 B.C. Both the ancient Greek physician Hippocrates (460-375 B.C.) and Roman anatomist Galen (130-199 A.D.) believed air contained a substance vital to life. Renaissance innovators Leonardo da Vinci (1453-1519) and Andreas Vesalius (1514-1564) learned the lungs were inflated with sub-atmospheric pressures and experimented with resuscitation. Still, it was not until the 1770s that oxygen was discovered by English chemist Joseph Priestley, and physician Thomas Beddoes first used it to treat physical ailments.

Even though breathing is critical for the sustainability of life, the health profession dedicated to respiration is still relatively young. In fall 2024, UNMC’s College of Allied Health Professions will launch the ninth master of respiratory therapy education program in the United States.

Anesthesia Mask, c. 1900

Courtesy of the Stuhr Museum of the Prairie Pioneer

The Rise of Anesthesia, 1800-1920

Today, most medical procedures are designed to be as painless as possible for the patient. But this was not the case before October 16, 1846. “Ether Day” commemorated William Thomas Green’s use of an inhaled anesthetic in a dental surgical procedure.

Ether, or “sweet oil of vitriol,” was first synthesized by Valerius Cordus in 1540. Joseph Priestley discovered nitrous oxide or “laughing gas” in 1772 and its use in surgery was first suggested as early as 1800. However, these compounds were primarily used for entertainment or recreational purposes until the 1840s, when both were used in dental procedures. The goal was to relieve pain and help patients recover quickly from the effects of the compounds.

After Louis Pasteur brought forth his “germ theory” in 1865 and antisepsis became routine, more complex and lengthy surgeries began to be performed. These developments required changes to inhaled anesthetic procedures and compounds.

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Nebulizers and atomizers

Nebulizers and atomizers speed the absorption of medications directly into the blood stream by applying them to the mucosal membranes of the nose and throat. This method of medicating patients is fast, safe, and painless.

Nebulizer, c. 19th century

Donated by Charles W. Guildner, MD, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

DeVilbiss No. 6 Atomizer, c. 1890s

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

DeVilbiss Atomizer, c. 1890

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

Defender Atomizer, c. 1945

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

Nyal Nasal Drops, c. 1970

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

Wyeth Edryl Antibiotic Nasal Decongestant

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

Pharmaceutical Oils
Pharmaceutical Oils, c. 1910s

Donated by the Department of Pharmaceutical Practice, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

The Oxygen Era and Birth of a Profession, 1900-1940

Much like ether and nitrous oxide, oxygen therapy began as a recreational past-time in Germany in the 1770s. It was used sporadically for medicinal purposes through the mid-19th century and was advertised as a “cure all” treatment.

In 1900, Dr. Albert Blodgett attempted the first recorded application of continuous administration of oxygen on a 46-year-old female patient with pneumonia. The goal was to alleviate symptoms of suffocation in her final hours, but surprisingly she was able to continue to breathe and eventually recovered.

By 1928, oxygen’s positive effects on survival rates were identified. Transporting, monitoring, administering, and cleaning of equipment used in oxygen treatments were added to the duties of nurses and then nursing assistants. Primitive regulators without gauges made it difficult to determine if the tanks were full. By the 1940s, technicians were employed specifically to handle the oxygen therapy required by patients. This was the first segmentation of a respiratory therapy-focused specialty in healthcare.

 

 

 

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Patient in Iron Lung
Iron Lung Patient, c. 1960

Courtesy of the Centers for Disease Control and Prevention Public Health Image Library

Mechanical Ventilation and The Iron Lung, 1940-1955

Mechanical ventilation originated in the 17th century when scientist Robert Hooke demonstrated that the damaged lungs of a dog could continue to function with the application of a bellows to blow air directly into them. Still, positive pressure breathing devices did not become available until 1900. The development of the well-known intensive care unit ventilator did not begin until 1940.

The most common image of assisted breathing technology in the 20th century was the tank respirator, commonly called “the iron lung.” Rising to prominence in treating patients with poliomyelitis, the iron lung’s development can be traced to 1927 at Harvard University. Seeing that one in every 200 patients infected with the polio virus suffered some type of paralysis—including of the respiratory system—Philip Brinker and Louis Agassiz Shaw developed a machine that could do the breathing for the patient. The positive and negative pressures squeeze the patient’s body for exhalation and relax for inhalation, thereby allowing the patient to breathe.

In 1952, 52,628 cases of polio were reported in the United States alone. With the advent of vaccinations in the 1950s and 60s, polio cases declined, and the virus was eventually eradicated. Iron lungs went from being a hospital equipment staple to a museum curiosity in less than half a century.

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Vaporizers

Vaporizers increase the humidity in a room or building by adding water vapor to the air. These steam vaporizers boil water and release the hot steam into the air.

The Turpo Vaporizer allowed the addition of a “Turpentine, Menthol, and Camphor” ointment to the water to provide relief of “head and chest colds, asthma, congestion, and similar complaints."

KwikWay Electric Vaporizer, c. 1936

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

American Electric Vaporizer No. 11, c. 1930

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

Turpo Electric Vaporizer, c. 1930

Donated by Darcy O’Brien-Genrich, MPA, RRT, Manager of Respiratory Care Services at Nebraska Medicine, from the McGoogan Health Sciences Library Robert S. Wigton Department of Special Collections and Archives

Respiratory Therapy Care at Nebraska Medicine
Respiratory Therapy Care at Nebraska Medicine, June 2023

Courtesy of the UNMC Department of Strategic Communications

The Rise and Acceptance of Respiratory Therapists, 1955-2000

One mark of a profession is the establishment of a professional society. In 1947, the University of Chicago chartered the Inhalation Therapy Association. Following the impact of viruses like polio and the advent of increasingly complicated treatments and surgeries, the specialized understanding of respiration became more and more necessary. The first formal training program for respiratory/inhalation therapists was established at the University of Chicago in 1950. In the 1960s, the number of programs grew, and most were hospital-based. By 1974, the professional designation of “Respiratory Therapist” became standard practice in the U.S. and Canada.

In 1980, the National Board for Respiratory Care began to offer state licensure exams for respiratory therapists. The first “Respiratory Care Week” was proclaimed by President Ronald Reagan in October 1982 to promote the profession and focus public attention on the importance of good lung health. This annual celebration continues today.

In 1986, the American Association for Respiratory Care underwent its most recent name change. It remains the national professional organization and continuing education affiliate for practicing respiratory therapists.

 

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Respirator Monitors and Charts

These respiratory monitors allow a patient to blow into a disposable mouthpiece to measure their maximum rate of exhalation. First developed in the 1940s, this 2-pound apparatus gave health care practitioners a portable testing option outside the laboratory.

Ferraris Wright Peak Flow Meter, c. 1980

Courtesy of Lisa Fuchs, EdD, from Children’s Memorial Hospital

Wright Peak Flow Meter, c. 1950s

Courtesy of Lisa Fuchs, EdD, from Children’s Memorial Hospital

Alveolar Air Equation Card, c. 1990s

Courtesy of Nebraska Medicine Respiratory Care Services

Common Drug Dosages Chart, c. 1990s

Courtesy of Nebraska Medicine Respiratory Care Services

Lung Function Calculator, c. 1990s

Courtesy of Nebraska Medicine Respiratory Care Services

pH Blood Gas Calculator, c. 1990s

Courtesy of Nebraska Medicine Respiratory Care Services

UNMC Respiratory Care Program, c. 2023

Courtesy of the College of Allied Health Professions

Formalizing and Educating a Professional Workforce, 2000-present

In 2004, Vermont became the 48th state to pass the Respiratory Care Act that allowed the practice of respiratory care to be given in a state, province, region, or nation. With this action, legal professional credentialing was brought to all 48 contiguous states in the U.S.

Today, Respiratory Therapy is a profession recognized globally. Its impact and need within the healthcare system is acknowledged and valued, and the number of educational programs continues to grow. As an allied health profession, respiratory therapists partner with physicians and nurses to treat a variety of patients. They assist with diagnosing lung and breathing disorders, provide testing, determine appropriate therapies, perform laboratory analysis on blood and sputum, manage breathing equipment and devices, and educate patients and families about lung diseases and disorders.

As a profession that the Bureau of Labor and Statistics expects to grow much faster than average, respiratory therapists are in high demand. . In 2024, UNMC’s College of Allied Health Professions will launch a Master of Respiratory Therapy Program with an entry-into-practice degree (9th in the U.S.), a Degree Advancement Option (5th in the U.S.) that will confer a Master of Respiratory Care (MRC) degree upon graduation. Offered in both Omaha and Kearney, these newly developed programs will provide Nebraska and the nation with quality health care practitioners by offering education and clinical opportunities at the highest level of practice.  

 

Explore UNMC's Respiratory Care Program

 

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