Respiratory problems (RPs) are the main cause of death in patients with amyotrophic lateral sclerosis (ALS).1–2 However, nowadays many of these RPs can be successfully managed.3 Therefore, it is disturbing to see that a great number of patients are not receiving appropriate management for their RPs, with the consequences of premature death and avoidable suffering. The very interesting report by Farrero et al in this issue of CHEST (see page 2132) describes the impact on survival of patients when applying two different ways of tackling their management. The first could be called the conventional approach (which is more or less the way the patients were attended in this study from 1988 to 1997). The second way is the appropriate approach, in which the neurologists, being aware of the gravity of RPs in these patients,,3 coordinate their management with the pulmonologists (in some hospitals with the Physical Medicine and Rehabilitation Department staff) once they have a diagnosis. The pulmonologists take on the responsibility of designing a protocol for good clinical practice to prevent and treat the RPs.