Neodymium-YAG laser therapy of malignant obstructing airway lesions via a flexible endoscope offers a promising new means of treatment. Twenty-two patients with obstructing airway lesions were treated. Two fatal complications occurred. The patients experienced increased comfort in breathing, increased exercise tolerance, and more effective cough with clearance of secretions. Treatment of larger numbers of patients with careful monitoring of the results should be performed to define further the usefulness, complications, and limitations of this new therapeutic tool.