In the past, it has been difficult to prove which outcomes are directly attributable to the activity of respiratory nurse specialists (RNS). Emerging evidence suggests that RNSs can produce outcomes in many areas of respiratory medicine that are effective and safe. The RNS is likely to be most effective at the center of the multidisciplinary team. A shared approach to patient care can produce improvements in quality of life and function. This facilitates governmental policy for patients with chronic, relapsing diseases which are characteristic of many respiratory illnesses. An expansion of the RNS's responsibilities brings increased autonomy and accountability. RNSs must be sure they have the relevant depth and scope of knowledge to undertake their particular roles. The purpose of this paper is to discuss the varied roles and documented effectiveness of a nurse specializing in the care of respiratory nursing.