Pulmonary problems are a major source of morbidity and mortality, especially among patients with severe cerebral palsy. The pulmonary problem can exist at multiple levels, including the respiratory centers of the brain, airways, lung parenchyma, pulmonary vasculature, and chest wall. Careful assessment and therapies targeted to each are needed to optimize care. Immunization against pulmonary diseases is of paramount importance. Invasive management, such as orthopedic procedures, or the institution of mechanical ventilation must be carefully considered in the context of the patient’s medical condition, family’s value system, and capabilities of the home and local medical system. Pulmonary problems, physiology, assessment, importance of immunizations, and therapies are reviewed in this chapter.