1. Chapter 1 History of Respiratory Care
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2. Learning Objectives Define “respiratory care.”
Summarize some of the major events in the
history of science & medicine.
Explain how the respiratory care profession got started.
Describe the historical development of the major clinical areas of respiratory care.
Name some of the important historical figures in respiratory care.
Describe the major respiratory care educational, credentialing, & professional associations.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

3. Learning Objectives
Explain how the important respiratory care organizations got started.
Describe the development of respiratory care
education.
Predict future trends for respiratory care.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

4. History of Respiratory Medicine & Science
Ancient Times
Early cultures developed herbal remedies for many diseases
Foundation of modern medicine: attributed to “father of medicine,” Hippocrates, Greek physician living during 5th & 4th centuries BC
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

5. History of Respiratory Medicine & Science (cont.)
Ancient Times (cont.)
Hippocratic medicine:based on four essential
fluids: phlegm, blood, yellow bile, & black bile
Hippocrates believed air contained essential substance distributed to body via heart
The Hippocratic oath: calls for physicians to follow certain ethical principles
Given to most medical students at graduation
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6. History of Respiratory Medicine & Science (cont.)
Middle Ages
Fall of Roman empire (476 AD): resulted in period
of slow scientific progress
Intellectual rebirth in Europe began in 12th century
Leonardo da Vinci (14531519) determined
subatmospheric pressures inflated lungs
Andreas Vesalius (15141564) performed human dissections & experimented with resuscitation
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7. History of Respiratory Medicine & Science (cont.)
Enlightenment Period
1754: Joseph Black described properties of CO2
1774: Joseph Priestley describes his discovery of oxygen.
1787: Jacques Charles describes relationship between gas temperature & volume - “Charles law”
1798: Thomas Beddoes uses oxygen to treat
various conditions at Pneumatic Institute
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8. History of Respiratory Medicine & Science (cont.)
19th & Early 20th Century
1801: John Dalton describes his law of partial pressures
1808: Joseph Louis Gay-Lussac describes relationship between gas temperature & pressure
1831: Thomas Graham describes law of diffusion
for gases (Graham’s law)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

9. History of Respiratory Medicine & Science (cont.)
19th & Early 20th Century (cont.)
1846: spirometer & measures the vital capacity
1865: Louis Pasteur advanced his “germ theory” & suggestes that some diseases were result of microorganisms
1895: William Roentgen discoveres x-ray - opens
door for modern field of radiology
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

10. Which scientist described his law of diffusion for
gases in the 19th century?
John Dalton
Thomas Graham
Jacques Charles
Joseph Louis Gay-Lussac
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11. Development of the Respiratory Care Profession
1940s: technicians hauled O2 cylinders & apply O2 delivery devices
1950s: positive-pressure breathing devices applied to patients
1960s: Formal education programs for inhalation therapists
Development of sophisticated mechanical ventilators in the 1960s expanded role of respiratory therapist (RT)
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12. Development of the Respiratory Care Profession (cont.)
RTs responsible for arterial blood gas & pulmonary function laboratories
1974: designation “respiratory therapist” becomes
standard
Practice of Respiratory Therapy, originally U.S. & Canada now expands globally
1980: Respiratory Care Week established nationally to promote profession & importance of good lung health ( 3rd week of October)
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13. How long after initially applying positive pressure breathing devices to patients did the first sophisticated mechanical ventilator become available, expanding the role of Respiratory Therapists?
10 years
20 years
30 years
40 years
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

14. Development of the Respiratory Care Profession (cont.)
Oxygen Therapy
1907: Large-scale production of O2 developed by Karl von Linde.
1910: Oxygen tents first used
1918: O2 masks first used
1940s: O2 therapy widely prescribed
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

15. Development of the Respiratory Care Profession (cont.)
1960s: Clark electrode first developed - allows measurement of arterial PO2
1974: Ear oximeter invented
1980s: Pulse oximeter invented
1960: Venti mask to deliver specific FIO2 introduced
1970s: Portable liquid O2 systems for long-term oxygen therapy (LTOT) in home introduced
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

16. Development of the Respiratory Care Profession (cont.)
21st century marks further advances in home oxygen therapy equipment
New equipment introduced for Long Term Oxygen Therapy include:
Oxygen concentrators with pressure booster
(allows transfilling in home)
Smaller, lightweight portable oxygen concentrators
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17. Development of the Respiratory Care Profession (cont.)
Aerosol Medications
1910: aerosolized epinephrine introduced as treatment for asthma
1940s-1950s: Isoproterenol (1940) & isoetharine (1951) introduced as bronchodilators
1971s: Aerosolized steroids first used to treat acute asthma
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18. Development of the Respiratory Care Profession (cont.)
Aerosol Medications
1980: Advances in bronchodilator therapy - Albuterol sulfate introduced & still used today
2000: Levalbuteral introduced
Newer aerosol medication delivery devices include dry powder inhaler (DPI)
Innovative designs for small volume nebulizers (SVN’s) invented
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19. Development of the Respiratory Care Profession (cont.)
Mechanical Ventilation
1928: Iron lung introduced by Philip Drinker
1940s-1950s: Jack Emerson develops improved version of iron lung used for polio victims
1950s: Negative-pressure “wrap” ventilator introduced
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20. Development of the Respiratory Care
Profession
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.

21. Mechanical Ventilation
 Originally, positive-pressure ventilation was used during anesthesia.
 The Drager Pulmotor (1911), the Spiropulsator (1934), the Bennett TV-2P (1948) and Bird Mark 7
(1958) were positive-pressure ventilators.
 The Bennett MA-1, Ohio 560, and Engstrom 300 were introduced in the 1960s as volume-cycled ventilators.
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22. Mechanical Ventilation (cont.)
More advanced volume ventilators became available in the 1970s:
Servo 900, Bourns Bear I and II, and MA II.
The first microprocessor-controlled ventilators were developed in the 1980s (Bennett 7200).
Ventilators with the capability of applying advanced modes of ventilation became available in the 21st century.
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23. Airway Management
1980: William MacEwen successfully applied first endotracheal tube to patient
1913: laryngoscope introduced
1941: First suction catheter described
1970s: Low-pressure cuffs for endotracheal
tubes introduced
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24. Cardiopulmonary Diagnostics
1800: Measurement of lung’s residual volume first performed
1846: first water-sealed spirometer developed by
John Hutchinson
1967: rapid arterial blood gas analysis becomes
available
1980s: Polysomnography becomes routine
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25. Professional Organizations
Inhalation Therapy Association (ITA) founded in 1947
ITA became American Association for
Inhalation Therapists (AAIT) founded in 1954
AAIT became American Association for
Respiratory Therapy (AART) founded 1973
AART became American Association for
Respiratory Care (AARC) founded in 1982
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26. Professional Organizations (cont.)
1980s: state licensure for RTs begins
State licensure based on RTs passing entry level exam offered by National Board for Respiratory Care (NBRC)
NBRC offers certification & registry examination for
RTs
State licensing laws set minimum educational requirements & determine competence to practice
State licensing boards also set required amount of continuing education credits (CEU’s) required to keep license to practice
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27. Professional Organizations (cont.)
AARC advocates for profession to legislative &
regulatory bodies, insurance industry & public
AARC sponsors continuing professional educational activities, including conferences to gain CEU’s - go to
AARC publishes monthly science journal RESPIRATORY CARE & news magazine: AARC Times
AARC members may join any of 10 Specialty Sections
2002: AARC, NBRC, & CoARC formally express support for all RT’s to seek & obtain RRT credential
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28. Summary of RT organizations
AARC: national organization, sets national standards for the profession, primary adovacy group
NBRC: Credentialing body, must pass this national test to become licensed. They are responsible for all credentialing (CRT, RRT, NPS…)
COARC: agency responsible for maintaining RT educational programs
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29. In what year did it become a requirement for Respiratory Therapists to be licensed by the state in which they practice?
A. 2000
B. 1990
C. 1980
D. 1970
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30. Respiratory Care Education
1950: First formal RT program was offered in
Chicago
1960s: Programs multiply - many hospital based
Currently: Associates (AS) Degree in Respiratory
Care (RC) is minimum educational requirement
AS Degree’s represent majority of all educational programs
More than 350 RT education programs exist in U.S.
2003: AARC formally encourages development of baccalaureate & graduate education in RC
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31. Respiratory Care Education
Due to aging population(baby boomers):
Increased demand for RC services & RT’s
As baby boomers age:
More will have asthma, COPD, & other cardiopulmonary diseases
As treatments & technology continue to advance:
RT’s will require more educational preparation
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32. Respiratory Care Education
RT’s of future will focus more on:
Prevention
Protocol administration
Care plan development
Disease management & rehabilitation
Family & patient education
Tobacco cessation counseling
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33. Future of Respiratory Care (cont.)
Task force concludes: RT’s need to be competent in 7 major areas:
Diagnostics
Chronic disease state management
Evidence-based medicine & Respiratory Care protocols
Patient Assessment
Leadership
Emergency & Critical Care
Therapeutics
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