How to Become a Respiratory Therapist in 2026: Complete Licensing Guide

Respiratory therapists are essential healthcare professionals who evaluate, treat, and care for patients with breathing disorders and cardiopulmonary conditions. Across the 51 states we track, 50 require licensure or credentialing, and initial fees range from $220 to $615.

This guide covers everything you need to know about becoming a respiratory therapist in 2026 -- from education and accreditation to national board exams, state licensure, and career outlook.

What Does a Respiratory Therapist Do?

Respiratory therapists (RTs) are licensed healthcare professionals who specialize in cardiopulmonary care. They work with patients of all ages -- from premature infants with undeveloped lungs to elderly patients with chronic obstructive pulmonary disease (COPD). Their day-to-day responsibilities include:

• Diagnostic testing: Performing pulmonary function tests (PFTs), arterial blood gas (ABG) analysis, and sleep studies to assess lung function and oxygenation
• Mechanical ventilation: Setting up, managing, and weaning patients from ventilators in ICUs, emergency departments, and operating rooms
• Airway management: Intubation, extubation, and maintaining artificial airways for critically ill patients
• Medication delivery: Administering aerosolized medications such as bronchodilators, corticosteroids, and mucolytics via nebulizers and metered-dose inhalers
• Emergency and critical care: Responding to code blue and rapid response calls, performing CPR, and managing emergency airways
• Patient education: Teaching patients with asthma, COPD, cystic fibrosis, and other chronic conditions how to manage their disease, use inhalers, and follow treatment plans
• Neonatal and pediatric care: Providing specialized respiratory support to newborns in NICUs, including surfactant therapy and high-frequency ventilation

Respiratory therapists work in hospitals, intensive care units, emergency departments, pulmonary rehabilitation clinics, sleep disorder centers, home health agencies, and long-term care facilities. The profession is known for its high demand, competitive salaries, and meaningful patient impact.

Education Requirements

To become a respiratory therapist, you must graduate from a respiratory therapy program accredited by the Commission on Accreditation for Respiratory Care (CoARC). Programs are available at two primary levels:

CoARC accreditation is essential. Currently, 50 of 51 states explicitly require graduation from a CoARC-accredited program for licensure. Even in states where it is not explicitly stated, the NBRC exams require CoARC-accredited education as an eligibility prerequisite.

What Is CoARC Accreditation?

The Commission on Accreditation for Respiratory Care (CoARC) is the recognized accrediting body for respiratory therapy education programs in the United States. CoARC ensures that programs meet rigorous standards for curriculum content, faculty qualifications, clinical resources, and student outcomes. There are approximately 450 CoARC-accredited programs across the country.

What You Learn in Respiratory Therapy School

• Cardiopulmonary anatomy and physiology: Heart-lung interactions, gas exchange, and respiratory mechanics
• Pharmacology: Bronchodilators, corticosteroids, anti-infectives, and other respiratory medications
• Mechanical ventilation: Modes of ventilation, patient-ventilator synchrony, and weaning protocols
• Diagnostics: Pulmonary function testing, arterial blood gas interpretation, polysomnography, and hemodynamic monitoring
• Neonatal and pediatric respiratory care: Specialized techniques for infants and children
• Clinical rotations: Hands-on experience in hospital settings including ICU, emergency department, and pulmonary rehabilitation

CRT vs. RRT: Understanding the Credentials

The National Board for Respiratory Care (NBRC) offers two primary credentials for respiratory therapists. Understanding the difference is critical because state licensing requirements vary based on which credential level you hold.

The AARC (American Association for Respiratory Care) and many industry leaders advocate for the RRT as the standard of practice. An increasing number of states are transitioning toward requiring the RRT as the minimum credential for licensure.

NBRC Exams: TMC and CSE

The National Board for Respiratory Care (NBRC) administers the credentialing exams that all respiratory therapists must pass. There are two primary exams:

Therapist Multiple-Choice (TMC) Exam

• Format: 160 multiple-choice questions (140 scored, 20 pretest items) covering patient data evaluation, troubleshooting, and clinical decision-making
• Duration: 3 hours
• Scoring: Two cut scores -- the low-cut score earns the CRT credential, the high-cut score qualifies you to sit for the CSE (toward the RRT)
• Fee: Approximately $190
• Eligibility: Must have completed or be in the final semester of a CoARC-accredited program
• Delivery: Computer-based testing at Pearson VUE test centers nationwide

Clinical Simulation Exam (CSE)

• Format: 22 clinical simulation problems (branching logic scenarios) that test your ability to gather information, make decisions, and manage patients in realistic clinical situations
• Duration: 4 hours
• Prerequisite: Must have achieved the high-cut score on the TMC exam
• Fee: Approximately $200
• Result: Passing the CSE (combined with the TMC high-cut score) earns the RRT credential
• Delivery: Computer-based testing at Pearson VUE test centers

Both exams can be retaken if you do not pass on the first attempt. The NBRC allows up to three attempts per 12-month eligibility period. Exam content is based on the NBRC's detailed content outlines, which are updated periodically to reflect current clinical practice.

Steps to Become a Respiratory Therapist

Step 1: Complete a CoARC-Accredited Program

Earn an associate's or bachelor's degree from a CoARC-accredited respiratory therapy program. Ensure your program meets your state's specific educational requirements. A bachelor's degree is increasingly recommended and may become the standard minimum entry level in the coming years.

Step 2: Pass the TMC Exam (Earn CRT or RRT Eligibility)

After completing your education, sit for the NBRC Therapist Multiple-Choice (TMC) Exam. Achieving the low-cut score earns you the CRT credential. Achieving the high-cut score makes you eligible to take the Clinical Simulation Exam (CSE) toward the RRT credential.

Step 3: Pass the CSE (Earn the RRT)

If you achieved the TMC high-cut score, take and pass the Clinical Simulation Exam to earn the RRT credential. The RRT is the preferred credential for most employers and is required as the minimum in 3 states. Even if your state accepts the CRT, pursuing the RRT is strongly recommended for career advancement.

Step 4: Apply for State Licensure

With your NBRC credential(s) in hand, apply for licensure through your state's medical or respiratory care board. The application typically requires:

1. Official transcripts from your CoARC-accredited program
2. NBRC credential verification (CRT and/or RRT)
3. Background check and/or fingerprinting
4. CPR/BLS certification (current)
5. Application fee payment (ranges from $220 to $615)
6. Jurisprudence exam (required in some states)

Processing times vary from 2-8 weeks depending on the state. Some states offer temporary permits that allow you to practice while your application is being reviewed.

Step 5: Maintain Your License

Once licensed, you must maintain your credentials through continuing education and timely renewal. Most states require ongoing CE hours, current NBRC credentials, and payment of renewal fees. Failing to renew on time can result in license lapse and the need to reapply.

State-by-State Respiratory Therapist Requirements

The table below summarizes key respiratory therapist licensing requirements across all 51 states we track. Click any state for the full breakdown of requirements, fees, and renewal details.

States Not Requiring Licensure

While the vast majority of states require respiratory therapists to hold a state license, a small number of states do not have mandatory licensure requirements. In these 1 states, respiratory therapists may still need to hold NBRC credentials (CRT or RRT) but are not required to obtain a separate state license:

Even in states without mandatory licensure, most employers require NBRC credentials as a condition of employment. Holding the CRT or RRT demonstrates that you have met national standards of competency and is essentially a de facto requirement for practice nationwide.

States Requiring CoARC-Accredited Education

50 of 51 states explicitly require graduation from a CoARC-accredited respiratory therapy program as a condition of licensure:

Telehealth and Remote Practice

Telehealth has expanded rapidly in respiratory care, particularly for patient monitoring, education, and chronic disease management. Currently, 50 of 51 states explicitly allow respiratory therapists to practice via telehealth:

Telehealth services may include remote patient monitoring of ventilators and oxygen equipment, virtual pulmonary rehabilitation sessions, patient education and medication management, and disease management counseling for conditions like COPD and asthma.

Licensure Reciprocity

If you are already licensed in one state and want to practice in another, reciprocity policies determine whether your credentials transfer. These 50 states accept out-of-state respiratory therapist credentials through endorsement or reciprocity:

Most states that accept out-of-state credentials still require you to submit a new application, verify your NBRC credentials, pass a background check, and pay application fees. Some states may also require a jurisprudence exam covering state-specific laws and regulations.

Continuing Education and Renewal

All licensed respiratory therapists must meet continuing education (CE) requirements to maintain their license and NBRC credentials. Key aspects include:

• State CE requirements: Each state sets its own CE hour requirements per renewal period. Refer to the table above for state-specific requirements.
• NBRC credential maintenance: The NBRC requires 30 CE credits per 5-year cycle to maintain the CRT and RRT credentials. You must also maintain active NBRC credentials to keep your state license.
• Approved topics: CE may cover clinical practice, patient safety, ethics, new technology, disease management, and specialty areas like neonatal care or sleep medicine.
• Delivery methods: In-person conferences, webinars, online self-study courses, and journal articles are typically accepted.
• CPR/BLS: Must remain current throughout the license period.

Frequently Asked Questions

How long does it take to become a respiratory therapist?

An associate's degree program takes approximately 2 years, while a bachelor's degree takes 4 years. After graduation, you can typically complete the NBRC exams and state licensing process within 2-3 months. Including education and credentialing, expect 2.5 to 4.5 years from start to practice.

How much does it cost to become a respiratory therapist?

Education costs range from $10,000-$30,000 for an associate's degree at a community college to $40,000-$100,000+ for a bachelor's degree at a university. Additional costs include the TMC exam (~$190), CSE exam (~$200), and state licensing fees ($220 to $615). NBRC credential application fees add approximately $100-$150.

What is the difference between CRT and RRT?

The CRT (Certified Respiratory Therapist) is the entry-level credential earned by passing the TMC exam at the low-cut score. The RRT (Registered Respiratory Therapist) is the advanced credential earned by passing the TMC at the high-cut score and completing the Clinical Simulation Exam (CSE). The RRT is increasingly required by states and preferred by employers for advanced practice roles.

What is the job outlook for respiratory therapists?

The Bureau of Labor Statistics projects 13-14% growth for respiratory therapists through 2032, much faster than the average for all occupations. Demand is driven by an aging population with higher rates of respiratory conditions, advances in treating premature infants, and the ongoing need for critical care professionals. The median annual salary is approximately $77,000.

Can I practice in multiple states?

Yes, but you need a license in each state where you practice. 50 of 51 states accept out-of-state credentials through endorsement, which can simplify the process. There is currently no interstate compact for respiratory therapists, though one has been proposed. You may still need to meet state-specific requirements such as background checks or jurisprudence exams.

Can I become a respiratory therapist online?

Not entirely. Respiratory therapy programs require extensive hands-on clinical training in hospital settings that cannot be completed online. Some programs offer hybrid formats where didactic coursework is delivered online and clinical rotations are completed in person at affiliated healthcare facilities. Degree-completion programs (e.g., RRT-to-BSRT bridge programs) for already-credentialed therapists may have more online flexibility.

Next Steps

Click any state in the table above to see its complete respiratory therapist requirements. Each state page includes detailed information on education requirements, credential levels, exam procedures, fees, renewal processes, and scope of practice.

Sources

Education, exam, licensing, and fee data are sourced from official state respiratory care boards and national respiratory therapy organizations.

• Individual state respiratory care board websites (cited on each state page).
• National Board for Respiratory Care (NBRC) -- nbrc.org
• Commission on Accreditation for Respiratory Care (CoARC) -- coarc.com
• American Association for Respiratory Care (AARC) -- aarc.org
• Bureau of Labor Statistics -- Occupational Outlook Handbook, Respiratory Therapists.

Data was last verified in February 2026. Requirements can change as states update their regulations. Always confirm current requirements with your state's respiratory care board before enrolling in a program or applying for licensure.