In the first two years after the introduction of neodymium-yttrium-aluminum-garnet (Nd: YAG) laser therapy to our practice, 116 patients were treated 176 times. One hundred six patients (91.4 percent) were treated with the flexible fiberoptic bronchoscope. General anesthesia was used in 89.7 percent of treatments; there were four transient anesthetic complications. Three deaths from massive hemorrhage occurred in the first 59 treatments (first 30 patients). After laser power settings were reduced from 90 to 40 W, there were no further incidences of massive hemorrhage or death in the subsequent 117 treatments. The airway caliber was improved in 83.4 percent of treatments. The trachea, mainstem bronchi, and bronchus intermedius airway calibers were improved more often than those of the lobar bronchi. With lower laser power settings, Nd:YAG laser therapy is a safe and effective means of relieving airway obstruction. Thirty-six percent of patients were alive at one year. The median time to retreatment or death was 130 days.