Interest in noninvasive positive-pressure ventilation both as an alternative to intubation and mechanical ventilation and as a unique therapy has grown over recent years. Clinical and patient acceptance is highest in neuromuscular deficits, but supporting evidence for its use in chronic obstructive pulmonary disease is highly dependent on the application. This review considers the clinical implementation of noninvasive positive-pressure ventilation in acute respiratory failure, as a postextubation weaning alternative, in stable severe hypercapnic chronic obstructive pulmonary disease, in overlap syndrome, and for nocturnal oxygen desaturation. Some applications are well supported, leading to a cautious recommendation for its utilizatip4, whereas for others evidence is starkly conflicting. The clinical efficacy of noninvasive positive-pressure ventilation is vastly dependent on equipment, equipment-patient interface, pressure settings, physician's bedside manner, and experience of the center. Interpretation of the studies must take into account the foregoing factors along with the various ventilatory techniques and differing primary outcome measures. Generalizations can be made regarding indications and contraindications, but this is an area rife with exceptions. The subtle message from the clinical studies describes the importance of the clinical art applied from the palette of science and technology.