Chronic neuromuscular and chest wall disorders that affect the respiratory system are comprised of congenital, genetic, and acquired diseases. These varied disorders range from processes that involve the bony structures of the chest wall, such as kyphoscoliosis, to diseases that directly impair skeletal muscle function, such as the muscular dystrophies. These disparate diseases all share the common thread of adversely affecting respiratory function without directly involving lung parenchyma. As a group, these disorders comprise a significant fraction of the patient population that the respiratory or ICU health care provider encounters and pose challenges to the clinician, which can be as daunting as challenges encountered in patients with diseases that directly affect lung parenchyma.