Malignant central airway obstruction (MCAO) is seen in 15–20% of lung cancer patients as well as with metastases from other cancers, like breast, kidney, etc. It is defined as 50% or greater obstruction of trachea, mainstem bronchi, bronchus intermedius, and lobar bronchi. The patients with MCAO often present with life-threatening complications and have a poor prognosis. The management of these patients varies widely between institutions and specialties involved which has a negative impact on outcomes. Patients with MCAO should undergo detailed clinical assessment including CT scan of the chest. The main approach to management is therapeutic bronchoscopy under general anesthesia. Multimodality, therapeutic bronchoscopy provides the best chance of procedural success. In addition, these patients should be treated with definitive chemoradiation and/or surgery. A multidisciplinary, patient-centric approach is the key to optimize the outcomes.