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To evaluate the effects of current supportive care measures for the adult respiratory distress syndrome (ARDS) upon the upper airway, we studied 30 survivors of ARDS. All patients were interviewed and examined and performed inspiratory and expiratory maximal flow-volume curves more than six months after the onset of ARDS. Three women had developed symptomatic upper airway obstruction due to laryngotracheal stenosis 4 to 12 months after discharge from the hospital. Potential etiologic factors included difficult orotracheal intubation (one) and high tracheal cuff pressures (one). The three survivors who developed laryngotracheal stenoses did not differ from the 27 survivors of ARDS without symptomatic upper airway obstruction with respect to age, duration of tracheal intubation, or maximum level of positive end-expiratory pressure. Each patient with upper airway obstruction required more than one operation for laryngotracheal reconstruction. Although corrective surgery improved airflow, two survivors of ARDS had upper airway obstruction and exertional dyspnea more than five years after the ARDS. We conclude that upper airway obstruction is an important cause of dyspnea and impairment following ARDS. Exertional dyspnea weeks to months following treatment for ARDS suggests the possibility of laryngotracheal stenosis. (Chest 1988; 94:526-30)