The exacerbation of chronic lung disease, bronchospasm, atelectasis, pneumonia, and respiratory failure with prolonged mechanical ventilation are considered to be clinically relevant postoperative pulmonary complications associated with increased morbidity and mortality. Careful history taking and a thorough physical examination are the most sensitive ways to identify patients at risk. Lung function tests serve as management tools for optimizing preoperative therapy and to assess postoperative lung function and individual risk in lung resection candidates. Additional cardiopulmonary exercise testing provides valuable information in borderline cases. The cessation of smoking, optimizing nutritional status and physiotherapy serve to prevent postoperative pulmonary complications. Moreover, medical therapy is recommended, especially for patients with obstructive airway diseases. In the absence of controlled clinical trials, medical therapy along the respective guidelines, with the primary goals of minimizing symptoms and improving lung function to the optimum seems to be a reasonable approach.