Respiratory complications are a major cause of death in victims of fire and inhalation injury. The presence of inhalation injury dramatically increases mortality, even in the presence of relatively small burns. Thermal injury to the respiratory tract is usually associated with facial burns, steam inhalation, and inhalation of explosive gases. Inhaled smoke results in necrosis and desquamation of the respiratory epithelium, and alveolar pneumocytes, the latter resulting in alveolar edema and acute respiratory distress syndrome (ARDS). Patients who survive the initial injury may develop pneumonia and sepsis, with ARDS occurring later. Those who survive may develop bronchiolitis obliterans and hyperreactive airways.