inhalation therapy

WordNet

1. (medicine) the act of caring for someone (as by medication or remedial training etc.); "the quarterback is undergoing treatment for a knee injury"; "he tried every treatment the doctors suggested"; "heat therapy gave the best relief"
2. the act of inhaling; the drawing in of air (or other gases) as in breathing (同)inspiration, aspiration, intake, breathing in

PrepTutorEJDIC

1. (病気の)治療,療法 / =psychotherapy
2. 吸入;〈C〉吸入剤

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/03 23:25:57」(JST)

wiki en

[Wiki en表示]

Respiratory Therapist

A clinician auscultating the chest of a pediatric patient.
Occupation
Names	Respiratory therapist Respiratory practitioner Respiratory scientist Respiratory Nurse Clinical Respiratory Physiologist
Activity sectors	Nursing, Medicine, Allied Health
Description
Education required	Associate of Science in Respiratory Care Bachelor of Science in Respiratory Care Master of Science

A Respiratory Therapist is a specialized healthcare practitioner who has graduated from a college or a university and passed a national board certifying examination. Respiratory therapists work under the general supervision of a primary provider, such as physician or nurse practitioner most often in intensive care and operating rooms, but also in outpatient clinics.

Respiratory therapists are specialists and educators in cardiology and pulmonology. Respiratory therapists are also advanced-practice clinicians in airway management; establishing and maintaining the airway during management of trauma, intensive care, and may administer anaesthesia for surgery or conscious sedation.

Respiratory therapists often are in charge of initiating and managing life support for people in intensive care units and emergency departments, stabilizing, treating and managing pre-hospital and hospital-to-hospital patient transport by air or ground ambulance.

In the outpatient setting Respiratory Therapists are often educators in asthma clinics, ancillary clinical staff in pediatric clinics, and sleep-disorder diagnosticians in sleep-clinics. They also serve as ancillary clinical staff in cardiology clinics and cath-labs.

Clinical practice

Respiratory Therapist in an intensive care unit

Intensive care and operating room

Respiratory therapists educate, diagnose, and treat people who are suffering from heart and lung problems. Specialised in both cardiac and pulmonary care, Respiratory Therapists often collaborate with specialists in pulmonology and anaesthesia in various aspects of clinical care of patients. Respiratory therapists provide a vital role in both medicine and nursing.

Outpatient clinical practice

Respiratory therapists are also primary clinicians in conducting tests to measure lung function and teaching people to manage asthma, chronic obstructive pulmonary disorder among many other cardiac and lung functions.

Internationally, Respiratory Therapists that provide lung function testing are termed respiratory scientists, but in North America, they may be a Respiratory Therapist or may also be a certified pulmonary function technician in the United States.

Home-health care

Outside of clinics and hospitals, Respiratory Therapists often manage home oxygen needs of patients and their families, providing around the clock support for home ventilators and other equipment for conditions like sleep apnea.

In the clinic or outpatient setting Respiratory Therapists assist with diagnosis and serve as an educator for patients suffering from cardiac and respiratory illness. In the United States, Respiratory Therapists with certification as Registered Respiratory Therapists evaluate and treat patients with a great deal of autonomy under the direction of a pulmonologist. In facilities that maintain critical care transport teams Respiratory Therapists are a preferred addition to all types of surface or air transport.

Public education

In other settings Respiratory Therapists are found in schools as asthma educators, working with teachers and coaches about childhood symptoms of asthma and how to spot an emergency. In the United States, legislation has been introduced several times to allow Respiratory Therapists certified as asthma specialists with registered Respiratory Therapist certification to prescribe and manage previously diagnosed respiratory patients in physician clinics. In sleep clinics, Respiratory Therapists work with physicians in the diagnosis of sleep-related illnesses. Respiratory Therapists in the United States are migrating toward a role with autonomy similar to the nurse practitioner, or as an extension of the physician like the physician assistant. Respiratory Therapists are frequently utilized as complete cardiovascular specialists being utilized to place and manage arterial accesses along with peripherally-inserted central catheters.

A Respiratory Therapist gives an immunization shot to a patient

Pulmonary rehabilitation

Pulmonary rehabilitation may be initiated as a treatment as a source for continuity of improvement after a hospital stay or as a therapeutic way to increase quality of life. Pulmonary rehabilitation is intended to educate the patient, the family, and improve the overall quality of life and prognosis for the patient. Pulmonary Rehabilitation involves therapies and evaluations by Respiratory Therapists, Occupational Therapists and Physical Therapists.

Credentialing and licensure

United States and Canada

In the United States and Canada, Respiratory Therapists are healthcare professionals who, after receiving a degree in respiratory medicine or respiratory science complete a credentialing process. After satisfactorily completing the required examinations and added to a registry, the practitioner is then eligible to apply for a license to practice in the region governed by their respective licensing body. In the United States, specialist Respiratory Therapists are clinicians who hold National Board for Respiratory Care specialty credentials, which may include neonatal/pediatric specialist (CRT-NPS or RRT-NPS), adult critical care specialist (RRT-ACCS), sleep disorder specialist (CRT-SDS or RRT-SDS), and pulmonary function technologist (CPFT or RPFT). The NBRC's RRT-ACCS examination is the newest NBRC examination that was launched in 2012. Professional credentials denoted as a certified Asthma Educator (AE-C) may also be earned by passing the National Asthma Educator Certification Board (NAECB). In Canada, some similar credentialing exists, such as the Certified Respiratory Educator program.

International respiratory care

Except for the United States and Canada, very few countries have a dedicated professional role for respiratory health. In these countries, respiratory care is provided by physiotherapists, nurses and physicians that have chosen to specialize in this field. In many countries this recognition is in a transition stage; as an example, in 2011, hospitals in Beijing, China began a recruitment drive to acquire Respiratory Therapists for their intensive care units where previously nurses were the only clinician.

Canada

Upon graduation from an accredited school of respiratory therapy, the graduate is then eligible to write the national exam administered by the Canadian Board for Respiratory Care. Success on this examination will then allow the Respiratory Therapist to register with any licensing body in Canada. Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Quebec and Saskatchewan are the Canadian provinces with provincial licensing bodies; in these provinces, it is illegal to practice the profession of Respiratory Care without first being licensed as a full or practicing member with the provincial licensing body. These provinces are so-called regulated provinces. In all other jurisdictions, the licensing body for the profession of Respiratory Care is the Canadian Society for Respiratory Therapy. Registration as a full member is optional for Respiratory Therapists living in regulated provinces, however, for Respiratory Therapists living in non-regulated provinces, registration as a full member with the CSRT is compulsory. Registration with the provincial regulatory body or the CSRT (in non-regulated provinces) confers upon the Respiratory Therapist the title of Registered Respiratory Therapist (RRT).

France

Respiratory therapy is a sub-specialty of physical therapy in France. Respiratory care as a specialty is regulated by the Fédération Française des Masseurs Kinésithérapeutes Rééducateurs.

Germany

The German Respiratory Society first issued a resolution to develop the dedicated Respiratory Therapist (RT) role in 2004 as a means to increase the quality of patient care, delegate physician duties and respond to the observed increase in respiratory conditions and diseases. In 2006-2006, a year-long pilot training program was offered to established nurses and physiotherapists. Researchers report that significant additional work is necessary to define and position the role of the Respiratory Therapist within the current healthcare system.

Philippines

In Philippines Respiratory Therapists are clinicians who have been awarded at minimum a Bachelor of Science in Respiratory Care degree. Licenses to practice respiratory care are regulated by the Professional Regulatory Board of Respiratory Therapy and Professional Regulation Commission which is established and legally maintained by the Philippine Respiratory Therapy Act (Republic Act No. 10024).

United Arab Emirates

In United Arab Emirates Respiratory Therapists must have been awarded a Bachelor of Science in Respiratory Care. An additional two-years of experience is required for foreign applicants. Licenses are maintained and awarded by the Dubai Health Authority. The Dubai Health Authority restricts Respiratory Therapists to working only in physical medicine and rehabilitation Centers, in hospitals, in surgical clinics with cardio-thoracic surgeons and with physicians in family/general practice or pulmonology.

United States

A Respiratory Therapist teaches students about the dangers of smoking.

In the United States a Respiratory Therapist is a clinician who has at a minimum completed an Associate of Science in Respiratory Care degree along with a certification process. After satisfactorily completing required examinations either administered by the National Board for Respiratory Care or directly by the individual state licensing board (either the medical examiners board or a special state respiratory care board). There are two recognized governing bodies in the United States; the State Board of Respiratory Care in the state in which a Respiratory Therapist is licensed to practice and the other is the National Board for Respiratory Care (NBRC) a non-profit organization which regulates two levels of certification along with some additional specialist certifications. The Certified Respiratory Therapist (CRT) and the Registered Respiratory Therapist (RRT). The CRT is the certification given after successfully passing the entry-level examination NBRC-ELE; The RRT certification is given after first becoming a CRT and then passing the NBRC-WRE and NBRC-CSE.

Most state boards of respiratory care require proof of the appropriate NBRC credential and award various license titles; including (but not limited to) Respiratory Care Practitioner, Licensed Registered Respiratory Therapist, and Licensed Certified Respiratory Therapist. There has been a substantial push to standardize the state licensure by the American Association for Respiratory Care. The NBRC credential is renewed every 5 years for a fee in addition to fees assessed by the state boards of respiratory care.

United Kingdom

Respiratory therapy in the UK is not a recognized specific profession, but a specialization route available to physicians, nurses, physiotherapists and occupational therapists.

Common titles include Respiratory Nurse, Clinical Respiratory Physiologist, Cardio-Respiratory Physiotherapist and Cardio-Respiratory Occupational Therapist.

Physical therapists in training may either pursue a diploma or bachelor’s degree from an accredited post-secondary institution. At the diploma level, an individual receives a Diploma of Higher Education in Respiratory Care or Respiratory Disease Management.

At the degree level, a Bachelor of Science in Clinical Physiology is issued with a specialist option in respiratory physiology. Beyond the diploma and degree level, Master of Science programs in Respiratory Care, Respiratory Disease Management, Advanced Cardiology and Clinical Respiratory Physiology are available.

Specialist Respiratory Therapists

Anesthesia assistants

Anesthesia vaporizer

The traditional role of the operating room Respiratory Therapist has included providing technical support to the anesthesiologist for the proper use and maintenance of the anesthetic gas machine, in addition to also providing airway management. This role in the operating room has evolved to include a more advanced and specialized role with increasing responsibilities to the Respiratory Therapist. Like nurse anesthetists, Respiratory Therapists are academically prepared to perform activities such as sedation by administration of anesthetic gases and medications, insertion and management of vascular (arterial and venous) access and assessment of the depth of anesthesia under the guidance of an anesthesiologist or nurse anesthetist and under the authority of medical directives. This role is similar to the more main-steam nurse anesthetist profession, and is defined as equivalent by the United States regulations for anesthesia service providers.

Asthma specialists

Asthma specialists work with clinics, hospitals and schools as an educator for teachers, parents, patients and practitioners on asthma and allergies. Respiratory Therapists in the role as an Asthma Educator additionally help diagnose and treat asthma and other respiratory illness. Additionally, an Asthma Educator is the resource clinician in inpatient and outpatient environments for evaluating and advising physicians on treatment plans and helping facilitate patient understanding and compliance with the plan. In the United States, Certified Asthma Educators (AE-C) are credentialed by the National Asthma Education Certification Board (NAECB).

In Canada, the Canadian Network for Respiratory Care administers two certifications for the specialization as Respiratory Therapist Asthma Educator, the Certified Asthma Educator (CAE) (preferred by practitioners with a pediatric focus) and the Certified Respiratory Educator (CRE), which comprises the CAE program with additional training in COPD.

Cystic fibrosis

Respiratory Therapists work with people suffering from cystic fibrosis in clinics and hospitals by educating them about their disease and working with them on a treatment plan. While admitted to a hospital, patients with cystic fibrosis have their treatment schedule modified and maintained by Respiratory Therapists. Maintaining a healthy schedule for pharmokonetic and physical therapeutic airway clearance typically more frequent than home treatment plans because admissions are usually due to an increased need for therapy during the stay.

Cardiovascular perfusionist

CABG surgery with CPB

Respiratory Therapists are able to fulfill the role of Perfusionist with appropriate training. The perfusionist is a highly trained member of the cardiothoracic surgical team which consists of cardiac surgeons, anesthesiologists, physician assistants, surgical technicians, other Respiratory Therapists, and nurses. The perfusionist's main responsibility is to support the physiological and metabolic needs of the cardiac surgical patient so that the cardiac surgeon may operate on a still, unbeating heart. Perfusionist certifications are maintained and awarded by The American Academy of Cardiovascular Perfusion.

Extra-corporeal membrane oxygenation

A Respiratory Therapist takes a blood sample from a 3-day-old in preparation for transfer to an Extracorporeal Membrane Oxygenation unit

Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass technique used for the treatment of life threatening cardiac or respiratory failure. An ECMO Clinical Specialist is a technical specialist trained to manage the ECMO system including blood pump, tubing, artificial oxygenator, and related equipment. The ECMO Specialist, under qualified medical direction and supervision, is also responsible for the clinical needs of the patient on ECMO which may include bedside management of oxygenation and carbon dioxide removal, maintenance of normal acid-base balance, administration of medications, blood and blood products, and maintenance of appropriate anticoagulation therapies for the blood. This ECMO Clinical Specialist may be the bedside critical care nurse specifically trained in ECMO patient and circuit management, or the ECMO system may be primarily managed by a registered Respiratory Therapist, or physicians with training as ECMO clinical specialists.

Neonatal & pediatric intensive care

Much like adult intensivist Respiratory Therapists, neonatal and pediatric specialists deal primarily with managing life support for the pediatric or neonatal patient. Pediatric Respiratory Therapists are trained extensively in antenatal and intrapartum patients and family. In the United States a specialist certification exists and is awarded by the National Board for Respiratory Care. Available to Respiratory Therapists holding certification as a certified Respiratory Therapist or registered Respiratory Therapist however the registered Respiratory Therapist is preferred by most institutions.

Sleep disorder specialist

A pediatric patient prepared for a polysomnogram by a Respiratory Therapist.

Respiratory Therapists monitor, interpret and diagnose findings from a sleep study, as well as the medical history and physical exam to make the diagnosis and decide on treatment related to sleep-disorders. A sleep study can also help diagnose narcolepsy. In the United States a sleep disorder specialist can be a Registered Respiratory Therapist with the sleep disorder specialist certification (RRT-SDS) whom performs sleep disorders testing and therapeutic intervention along with diagnosis of sleep related disease such as Obstructive Sleep Apnea or Central Apnea. The role is very similar to the Polysomnographic technologist.

Case management

See also: Certified Case Manager

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human services needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Eligibility and certification is maintained by the Commission for Case Management Certification, a body certifying healthcare professionals in the United States.

Surface & air transport specialist

A premature infant on ECMO, a form of heart/lung machine, is being transferred between hospitals

Respiratory Therapists work with nurses, physicians, and paramedics in emergency flight and ground transport. They are a vital practitioner delivering care inside helicopters, air ambulance or ground ambulance working to pick up a patient and move them to a facility that has what they need. In the United States certification for transport (C-NPT) is currently awarded by The National Certification Corporation. The NREMT has included Respiratory Therapists as qualifying for the advanced credentialing as a critical care paramedic CCEMT-P.

Pulmonary research and science

Respiratory Therapists are sometimes referred to as Respiratory Scientists who are specialists in pulmonary function. Respiratory Therapists work with Pulmonologists in both clinical and general research of the respiratory system, ranging from the anatomy of the respiratory epithelium to the most effective treatment of pulmonary hypertension in pediatrics. Scientific research also takes place to look for causes and possible treatment in diseases such as asthma and lung cancer.

History of respiratory care

The profession of respiratory care was officially established over 60 years ago; and respiratory research has officially existed since the early 1900s. During the early years, Respiratory Therapists were referred to as "oxygen technicians", and most of their activities involved moving cylinders of compressed gas and administering oxygen via nasal catheter or oxygen tent. Most oxygen technicians were trained on the job, although brief training programs began to appear in the late 1940s and 1950s.

Today the profession hardly resembles what it was in the 1940s. Respiratory Therapists provide direct care, patient education, and care coordination. They are academically trained in respiratory nursing and respiratory medicine. They practice in acute care facilities, long-term acute care facilities, skilled nursing facilities, assisted-living centers, subacute care units, rehabilitation centers, diagnostics units, and in the home. Respiratory Therapist training has also dramatically changed. Current accreditation standards require Respiratory Therapists to have, at minimum, an Associate of Science in Respiratory Care degree from an accredited program. Legal requirements to practice respiratory therapy have also dramatically changed. 49 states now legally recognize Respiratory Therapists. Limited permits or state licenses are now required in all states except Alaska, which has no statutory authority over the practice of respiratory care. Most states that have a licensure requirement also require continuing education.

In 2007 the American Association for Respiratory Care (AARC) began developing recommendations for the promotion of the field of respiratory care in the United States in response to increased concern regarding licensure and credentialing issues as well as international recognition of those practicing in the United States. The task force decided to recommend that by 2015 the minimum education requirement for licensure and certification as a Respiratory Therapist be a bachelor of science in respiratory therapy (BSRT). The AARC task force also recommended the American Respiratory Care Foundation change its scholarship policies and only award assistance and grants to those working toward a bachelors degree. The Committee on Accreditation for Respiratory Care (CoARC) was asked by the AARC task force to change its accreditation standards and no longer accredit associates level respiratory care programs. The CoARC replied by a press release rejecting the recommendation. In 2011 legislation introduced by the AARC will help improve the use of Respiratory Therapists in clinical applications by allowing them to manage patients suffering from asthma and COPD seeing a clinic for routine checkups. Similar bills have been introduced before and have died in committee. 1111

See also

• Respiratory Care Associations — A list of respiratory therapy organizations
• Registered Respiratory Therapist — Becoming more prominent is the advanced practice Respiratory Therapist.
• Certified Respiratory Therapist — Formerly called a technician, this is the entry level therapist credential.
• American Association of Respiratory Care — The AARC is the only professional association for Respiratory Therapists in the United States.
• National Board for Respiratory Care — The NBRC is a non-profit credentialing agency keeping a registry of therapists in the United States and Latin America.
• Canadian Society of Respiratory Therapists – The national professional association for Respiratory Therapists in Canada.
• Respiratory Pharmacology - A list of important drugs used in the respiratory therapy field.

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における吸入剤の到達 delivery of inhaled medication in adults
• 2. 小児における吸入器の使用 the use of inhaler devices in children
• 3. 薬物療法の最新情報 whats new in drug therapy
• 4. 成人における肺高血圧症の治療 treatment of pulmonary hypertension in adults
• 5. 安定した慢性閉塞性肺疾患（COPD）のマネージメント management of stable chronic obstructive pulmonary disease

English Journal

• Change of right heart size and function by long-term therapy with riociguat in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.

• Marra AM1, Egenlauf B2, Ehlken N2, Fischer C3, Eichstaedt C2, Nagel C2, Bossone E4, Cittadini A5, Halank M6, Gall H7, Olsson KM8, Lange TJ9, Grünig E10.
• International journal of cardiology.Int J Cardiol.2015 Sep 15;195:19-26. doi: 10.1016/j.ijcard.2015.05.105. Epub 2015 May 19.
• BACKGROUND: Riociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The objective of this study was to evaluate the change of right heart size and function assessed by echocardiography during lo
• PMID 26011408

• Hypersensitivity Pneumonitis Caused by Cephalosporins With Identical R1 Side Chains.

• Lee SH1, Kim MH1, Lee K1, Jo EJ1, Park HK2.
• Allergy, asthma & immunology research.Allergy Asthma Immunol Res.2015 Sep;7(5):518-22. doi: 10.4168/aair.2015.7.5.518. Epub 2014 Nov 25.
• Drug-induced hypersensitivity pneumonitis results from interactions between pharmacologic agents and the human immune system. We describe a 54-year-old man with hypersensitivity pneumonitis caused by cephalosporins with identical R1 side chains. The patient, who complained of cough with sputum, was
• PMID 25749765

• Anaphylactic Shock Secondary to Intravenous Iron Sucrose in Chronic Kidney Disease.

• Behera V1, Chauhan R2, Sinha S2, Nair V3.
• Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion.Indian J Hematol Blood Transfus.2015 Sep;31(3):391-3. doi: 10.1007/s12288-014-0475-0. Epub 2014 Nov 18.
• Intravenous (IV) iron is an essential component of therapy of anemia of chronic kidney disease (CKD). We present a rare case in which iron sucrose was infused to a patient of CKD and resulted in severe anaphylaxis and cardiac arrest minutes after starting the infusion. He was aggressively resuscitat
• PMID 26085728

Japanese Journal

• 臨床研究・症例報告 小児気管支喘息の急性発作時のイソプロテレノール持続吸入療法の臨床的検討

• 池田 貴江,五十嵐 浩,俣野 美雪 [他]
• 小児科臨床 67(9), 1517-1521, 2014-09
• NAID 40020159374

• インフルエンザ感染症に合併した急性虫垂炎の2小児例

• 加藤 正也,今高 城治,岡本 健太郎,谷 有希子,山口 岳史,荻野 恵,土岡 丘,加藤 広行,有阪 治
• Dokkyo journal of medical sciences 41(2), 173-176, 2014-07-25
• 症例1は6歳女児.インフルエンザ感染症初日に発熱しオセルタミビルを開始.第3病日,右下腹部に限局した圧痛が出現.腹部造影CTで糞石を認め急性虫垂炎と診断.保存的に加療し炎症反応と腹痛は改善した.症例2は5歳女児.第1病日に発熱と腹痛を認め,第3病日に鼻咽腔迅速検査でインフルエンザB型と診断しザナミビル吸入を開始.触診で右下腹部に反跳痛を認め,腹部単純CTで虫垂壁の肥厚と糞石を確認.急性虫垂炎の併発 …
• NAID 110009815884

• 喘息治療薬開発の今後の展望 (特集 喘息予防・管理の最新の話題)

• 権 寧博,橋本 修
• 日本胸部臨床 73(7), 799-806, 2014-07
• NAID 40020149383

Related Links

• Inhalation Therapy | Flickr - Photo Sharing!

Roughly 9 x 12 inches. ... + Add JimFromIowa Member since 2005 Taken on July 7, 2012 Apple iPhone 4S 112 Views 0 Galleries

• inhalation therapy - definition of inhalation therapy in the ...

John Ducker, president and CEO, Fresenius Kabi USA, stated, "The introduction of Acetylcysteine Solution further illustrates Fresenius Kabi's commitment to meeting market needs in the short term, while broadening the availability ...

Related Pictures

---

★リンクテーブル★

リンク元	「吸入療法」「respiratory therapy」
関連記事	「therapy」

「吸入療法」

　　[★]

英

inhalation therapy

関

呼吸療法

「respiratory therapy」

　　[★]

呼吸療法

関

inhalation therapy

「therapy」

　　[★]

• n.

• 治療、治療法、療法

関

care、cure、curing、practice、psychotherapy、regimen、remediation、remedy、therapeutic、treat、treatment、treatment protocol