General principles in the management of acute respiratory distress in patients with lung cancer are influenced by the multiple causes of respiratory failure that are associated with cancer, lung cancer therapy and the presence of comorbid disease. In addition, the diagnosis may remain uncertain, even when invasive procedures are performed, and empirical therapy for the likely causes is frequently given. Finally, respiratory failure in patients with cancer results in high mortality (Groeger et al, 1999) requiring aggressive assessment and therapy.