Although personal respiratory protection is widely recognized as having a lower priority than reduction of any risk at source, respiratory protective equipment (RPE) is a major part of risk management for many employers. We have identified the key elements of what constitutes an effective risk control programme involving RPE, through a 3-fold approach involving (i) a review of the published scientific literature, (ii) exploring the issue through >40 years of research publications from the Institute of Occupational Medicine (IOM) (in which the ergonomics of personal protection equipment has been a significant thread), and (iii) a series of interviews and discussions with IOM and Health and Safety Executive staff with experience in the testing, prescription, or use of RPE. We have used the findings to formulate a series of recommendations for the constituents of an effective RPE programme. The role of management is paramount in recognizing the need for and providing appropriate RPE, which is both technically and ergonomically effective. Only then does any focus on the role of the employee, in wearing the RPE correctly at the appropriate times, becomes viable.