The indications, technique, and results of thoracoscopic talc poudrage in the two clinical settings of pneumothorax and recurrent pleural effusion in chronically ill patients are reported. Forty patients underwent this treatment between May 1982 and September 1989. The patients ranged in age from 10 months to 78 years. Of the 20 patients who underwent treatment of pneumothorax, 9 had cystic fibrosis, 7 had severe chronic obstructive pulmonary disease, 2 had spontaneous pneumothoraces, and 2 had postoperative parenchymal bronchopleural fistulas. Nineteen patients (95%) had successful treatment. Of the 20 patients who underwent treatment of chronic effusions, 14 had malignant etiologies, 3 had chylothoraces, and 3 had other miscellaneous effusions. Eighteen patients (90%) in this group had successful treatment. There were two hospital deaths related to the underlying disease processes after the pleural space problems were successfully treated. This study suggests that proper selection of patients and full exploitation of the capabilities of thoracoscopy and talc poudrage will result in effective treatment with low morbidity and mortality.