Chapter 1 – Early History of Respiratory Care

Learning Objectives

(1 of 2)

• Define respiratory care and its scope.

• Summarize major scientific and medical events that directly shaped modern respiratory care.

• Explain how the respiratory-care profession originated.

• Describe historical development of each clinical area in respiratory care.

• Name key historical figures whose work influenced respiratory care.

(2 of 2)

• Identify modern respiratory-care educational, credentialing, and professional associations.

• Explain how these organizations began and evolved.

• Describe the growth of respiratory-care education programs.

History of Respiratory Medicine & Science

Ancient Times

• Early civilizations created herbal remedies for pulmonary disease.

• Foundation of modern medicine attributed to Hippocrates (Greek, $5^{th} – 4^{th}$ centuries BC).

• Hypothesized four body fluids: phlegm, blood, yellow bile, black bile.

• Believed air contained an essential substance delivered throughout the body via the heart.

• Ethical legacy: Hippocratic Oath—guides physicians’ moral conduct.

• Other notable thinkers:

  • Aristotle ($342$–$322$ BC): first comprehensive biologist.

  • Erasistratus ($330$–$240$ BC): advanced pneumatic theory of respiration (Egypt).

  • Galen ($130$–$199$ AD): anatomic studies; insisted that air carried a vital life force.

Middle Ages

• Fall of Rome ($476$ AD) slowed scientific progress.

• Intellectual rebirth began $12^{th}$ century.

• Leonardo da Vinci ($1453$–$1519$): Demonstrated lungs inflate via sub-atmospheric pressure.

• Andreas Vesalius ($1514$–$1564$): Performed human dissections; experimented with resuscitation techniques.

Enlightenment Period

• Joseph Black ($1754$): Characterized CO₂ (“fixed air”).

• Joseph Priestley ($1774$): Isolated O₂ (“dephlogisticated air”).

• Lazzaro Spallanzani: Described tissue respiration.

• Jacques Charles ($1787$): Related gas temperature ➔ volume (→ Charles’ Law).

• Thomas Beddoes ($1778$): Applied O₂ therapy at the Pneumatic Institute.

$19^{th}$ & Early $20^{th}$ Centuries

• John Dalton ($1801$): Law of partial pressures (Dalton’s Law).

• Joseph Louis Gay-Lussac ($1808$): Gas temperature ↔ pressure relationship.

• Thomas Graham ($1831$): Law of diffusion for gases.

• Inventions:

  • $1846$: Spirometer & ether anesthesia.

  • Louis Pasteur ($1865$): Germ theory—microorganisms cause disease.

  • Robert Koch ($1882$): Isolated tubercle bacillus; formulated Koch’s postulates.

  • William Roentgen ($1896$): Discovered x-rays ⇒ birth of radiology.

Development of the Respiratory-Care Profession

Chronology of the Profession

• $1940s$: “O₂ technicians” transported cylinders & applied simple devices.

• $1950s$: Positive-pressure breathing devices enter clinical use.

• $1960s$: Formal inhalation-therapy education programs; advent of sophisticated mechanical ventilators ➔ larger RT role.

• Laboratory responsibilities added (arterial blood gases, pulmonary-function testing).

• $1974$: Title “Respiratory Therapist (RT)” standardized.

• Profession expands beyond U.S./Canada; $1980$: Respiratory Care Week established nationwide.

Oxygen Therapy

• $1907$: Karl von Linde enables large-scale O₂ production.

• $1910$: First oxygen tents.

• $1918$: Introduction of O₂ masks.

• $1940s$: Widespread prescription of O₂ therapy.

• Technological milestones:

  • Clark electrode ($1960s$): Direct $P<em>{aO</em>2}$ measurement.

  • Ear oximeter ($1974$).

  • Pulse oximeter ($1980s$).

  • Venturi (Venti) mask ($1960$): Precise $F<em>{iO</em>2}$ delivery.

  • Portable liquid O₂ systems for LTOT ($1970s$).

  • $21^{st}$-century: Home concentrators w/ pressure boosters (self-refilling), lightweight portable concentrators.

Aerosol Medications

• $1910$: Aerosolized epinephrine relieves asthma.

• Bronchodilators: Isoproterenol ($1940$), Isoetharine ($1951$).

• $1971$: Aerosolized steroids for acute asthma.

• $1980$: Albuterol (sulfate) released—still first-line SABA.

• $2000$: Levalbuterol introduced (isomer-specific).

• Device innovation: Dry-powder inhalers (DPIs), advanced small-volume nebulizers (SVNs).

Mechanical Ventilation

• Negative-pressure era:

  • Philip Drinker’s Iron Lung ($1928$).

  • Jack Emerson improves design (polio epidemics, $1940s–1950s$).

  • Chest cuirass & wrap ventilators ($1950s$).

• Positive-pressure lineage:

  • Dräger Pulmotor ($1911$), Spiropulsator ($1934$).

  • Bennett TV-2P ($1948$), Bird Mark 7 ($1958$).

  • Volume-cycled ventilators ($1960s$): Bennett MA-1, Ohio $560$, Engström $300$.

  • $1970s$: Servo $900$, Bourns Bear I/II, MA II.

  • $1980s$: First microprocessor-controlled unit—Bennett $7200$.

  • $21^{st}$-century: Multimode, closed-loop ventilators.

  • Patient-safety insight: Endotracheal tubes increase risk of ventilator-associated pneumonia (VAP); non-invasive ventilation (NIV) mitigates risk when feasible.

Airway Management

• William MacEwen ($1880$) places first successful endotracheal tube.

• Laryngoscope invented ($1913$).

• First suction catheter described ($1941$).

• Low-pressure cuffs for ETTs introduced ($1970s$) to decrease tracheal injury.

Cardiopulmonary Diagnostics & PFT

• $1679$: First measurement of deep-breath lung volume.

• $1800$: Determined residual volume.

• John Hutchinson ($1846$): Water-sealed spirometer.

• Rapid ABG analyzers available ($1967$).

• Polysomnography routine by $1980s$ (sleep-disorder diagnostics).

Professional Organizations

Evolution of the Association

• Inhalational Therapy Association (ITA) founded $1947$, Chicago.

• Renamed American Association for Inhalation Therapists (AAIT) $1954$.

• Became American Association for Respiratory Therapy (AART) $1973$.

• Current American Association for Respiratory Care (AARC) since $1982$.

• Membership reached $50{,}000$ by $2014$.

Credentialing & Licensure

• National Board for Respiratory Care (NBRC): Administers entry-level (CRT) & registry (RRT) exams.

• State licensure (began $1980s$) mandates:

  • Passing NBRC exam(s).

  • Minimum education standards.

  • Ongoing continuing-education units (CEUs) for renewal.

AARC Functions

• Advocacy with legislators, regulators, insurers, public.

• Continuing education: Conferences, online learning (earn CEUs).

• Publications: Respiratory Care (scientific journal) & AARC Times (news magazine).

• Specialty Sections: $10$ subspecial-interest groups.

• Tripartite Support (AARC–NBRC–CoARC, $2002$): Urged all RTs to achieve RRT credential.

Honors & Subsidiary Bodies

• FAARC (Fellow of AARC): Recognizes superior professional achievement & volunteerism.

• Board of Medical Advisors (BOMA): Physician advisory panel.

• American Respiratory Care Foundation (ARCF): Non-profit funding research & advanced training.

• International Council for Respiratory Care (ICRC): Promotes global standards & collaboration.

Professional Events

• Respiratory Care Week: Third week of October (annual).

• Raises public lung-health awareness.

• Showcases RT contributions across care settings.

• Opportunity for RT students to act as ambassadors on campus.

Respiratory-Care Education

Historical Growth

• First formal program: Chicago, $1950$.

• $1960s$: Rapid expansion—mostly hospital-based schools.

• Current U.S. landscape (approx.):

  • $443$ associate-degree programs.

  • $1$ in Puerto Rico.

  • $11$ graduate-degree programs.

  • International programs: Canada, Mexico, South America, Japan, India, Taiwan, Qatar, others.

• AARC $2003$ White Paper: Encouraged more baccalaureate & graduate programs.

Workforce Demand & Educational Imperative

• Aging “baby-boomer” cohort: Greater prevalence of asthma, COPD, cardiopulmonary disease.

• Technological complexity ⇒ RTs need advanced knowledge & skills.

• Tripartite Statement ($2002$): Endorsed universal pursuit of RRT credential.

Ethical, Philosophical & Practical Implications

• *Hippocratic

###### History of Respiratory Medicine & Science Ancient Times - Early civilizations created herbal remedies for pulmonary disease. - Foundation of modern medicine attributed to Hippocrates (Greek, $5^{th} – 4^{th}$ centuries BC). - Hypothesized four body fluids: phlegm, blood, yellow bile, black bile. - Believed air contained an essential substance delivered throughout the body via the heart. - Ethical legacy: Hippocratic Oath—guides physicians’ moral conduct. - Other notable thinkers: - Aristotle ($342$–$322$ BC): first comprehensive biologist. - Erasistratus ($330$–$240$ BC): advanced pneumatic theory of respiration (Egypt). - Galen ($130$–$199$ AD): anatomic studies; insisted that air carried a vital life force. Middle Ages - Fall of Rome ($476$ AD) slowed scientific progress. - Intellectual rebirth began $12^{th}$ century. - Leonardo da Vinci ($1453$–$1519$): Demonstrated lungs inflate via sub-atmospheric pressure. - Andreas Vesalius ($1514$–$1564$): Performed human dissections; experimented with resuscitation techniques. Enlightenment Period - Joseph Black ($1754$): Characterized CO₂ (“fixed air”). - Joseph Priestley ($1774$): Isolated O₂ (“dephlogisticated air”). - Lazzaro Spallanzani: Described tissue respiration. - Jacques Charles ($1787$): Related gas temperature ➔ volume (→ Charles’ Law). - Thomas Beddoes ($1778$): Applied O₂ therapy at the Pneumatic Institute. $19^{th}$ & Early $20^{th}$ Centuries - John Dalton ($1801$): Law of partial pressures (Dalton’s Law). - Joseph Louis Gay-Lussac ($1808$): Gas temperature ↔

pressure relationship. - Thomas Graham ($1831$): Law of diffusion for gases. - Inventions: - $1846$: Spirometer & ether anesthesia. - Louis Pasteur ($1865$): Germ theory—microorganisms cause disease. - Robert Koch ($1882$): Isolated tubercle bacillus; formulated Koch’s postulates. - William Roentgen ($1896$): Discovered x-rays ⇒ birth of radiology.

###### Development of the Respiratory-Care Profession Chronology of the Profession - $1940s$: “O₂ technicians” transported cylinders & applied simple devices. - $1950s$: Positive-pressure breathing devices enter clinical use. - $1960s$: Formal inhalation-therapy education programs; advent of sophisticated mechanical ventilators ➔ larger RT role. - Laboratory responsibilities added (arterial blood gases, pulmonary-function testing). - $1974$: Title “Respiratory Therapist (RT)” standardized. - Profession expands beyond U.S./Canada; $1980$: Respiratory Care Week established nationwide. Oxygen Therapy - $1907$: Karl von Linde enables large-scale O₂ production. - $1910$: First oxygen tents. - $1918$: Introduction of O₂ masks. - $1940s$: Widespread prescription of O₂ therapy. - Technological milestones: - Clark electrode ($1960s$): Direct P
*aO*2 measurement. - Ear oximeter ($1974$). - Pulse oximeter ($1980s$). - Venturi (Venti) mask ($1960$): Precise F
*iO*2 delivery. - Portable liquid O₂ systems for LTOT ($1970s$). - $21^{st}$-century: Home concentrators w/ pressure boosters (self-refilling), lightweight portable concentrators. Aerosol Medications - $1910$: Aerosolized epinephrine relieves asthma. - Bronchodilators: Isoproterenol ($1940$), Isoetharine ($1951$). - $1971$: Aerosolized steroids for acute asthma. - $1980$: Albuterol (sulfate) released—still first-line SABA. - $2000$: Levalbuterol introduced (isomer-specific). - Device innovation: Dry-powder inhalers (DPIs), advanced small-volume nebulizers (SVNs). Mechanical Ventilation - Negative-pressure era: - Philip Drinker’s Iron Lung ($1928$). - Jack Emerson improves design (polio epidemics, $1940s–1950s$). - Chest cuirass & wrap ventilators ($1950s$). - Positive-pressure lineage: - Dräger Pulmotor ($1911$), Spiropulsator ($1934$). - Bennett TV-2P ($1948$), Bird Mark 7 ($1958$). - Volume-cycled ventilators ($1960s$): Bennett MA-1, Ohio $560$, Engström $300$. - $1970s$: Servo $900$, Bourns Bear I/II, MA II. - $1980s$: First microprocessor-controlled unit—Bennett $7200$. - $21^{st}$-century: Multimode, closed-loop ventilators. - Patient-safety insight: Endotracheal tubes increase risk of ventilator-associated pneumonia (VAP); non-invasive ventilation (NIV) mitigates risk when feasible. Airway Management - William MacEwen ($1880$) places first successful endotracheal tube. - Laryngoscope invented ($1913$). - First suction catheter described ($1941$). - Low-pressure cuffs for ETTs introduced ($1970s$) to decrease tracheal injury. Cardiopulmonary Diagnostics & PFT - $1679$: First measurement of deep-breath lung volume. - $1800$: Determined residual volume. - John Hutchinson ($1846$): Water-sealed spirometer. - Rapid ABG analyzers available ($1967$). - Polysomnography routine by $1980s$ (sleep-disorder diagnostics).

###### Professional Organizations Evolution of the Association - Inhalational Therapy Association (ITA) founded $1947$, Chicago. - Renamed American Association for Inhalation Therapists (AAIT) $1954$. - Became American Association for Respiratory Therapy (AART) $1973$. - Current American Association for Respiratory Care (AARC) since $1982$. - Membership reached $50{,}000$ by $2014$. Credentialing & Licensure - National Board for Respiratory Care (NBRC): Administers entry-level (CRT) & registry (RRT) exams. - State licensure (began $1980s$) mandates: - Passing NBRC exam(s). - Minimum education standards. - Ongoing continuing-education units (CEUs) for renewal. AARC Functions - Advocacy with legislators, regulators, insurers, public. - Continuing education: Conferences, online learning (earn CEUs). - Publications: Respiratory Care (scientific journal) & AARC Times (news magazine). - Specialty Sections: $10$ subspecial-interest groups. - Tripartite Support (AARC–NBRC–CoARC, $2002$): Urged all RTs to achieve RRT credential. Honors & Subsidiary Bodies - FAARC (Fellow of AARC): Recognizes superior professional achievement & volunteerism. - Board of Medical Advisors (BOMA): Physician advisory panel. - American Respiratory Care Foundation (ARCF): Non-profit funding research & advanced training. - International Council for Respiratory Care (ICRC): Promotes global standards & collaboration.

###### Professional Events - Respiratory Care Week: Third week of October (annual). - Raises public lung-health awareness. - Showcases RT contributions across care settings. - Opportunity for RT students to act as ambassadors on campus.

###### Respiratory-Care Education