A recent small study from a single hospital medical ward suggests that RTs educating inpatients and resident physicians on proper inhaler technique and appropriate respiratory therapy ordering practices increases treatment benefits for patients while simultaneously reducing overall hospital costs.3 These data support many existing inpatient policies and practices, advocating the use of inhalers over nebulizers. Many studies cited by Drs Fuhrman and Aranson highlight the important, effective contributions of RTs to inpatient services, such as ventilator weaning, or to diseases, such as cystic fibrosis. However, the salient feature of our debate is whether outpatient RTs practicing without direct physician supervision and billing independently for COPD-related educational activities is a high-value service. It is improper to simply extrapolate evidence for RTs’ effectiveness in other arenas to support an argument for their delivering high-value, cost-conscious COPD-related education. Rather, this remains an important hypothesis that warrants empirical testing.