Nonmalignant central airway obstruction (CAO) comprises a wide array of etiologies and disorders that can affect the trachea, mainstem bronchi, and bronchus intermedius, either structurally or functionally. Given the diverse causative pathologies, treatment has to be individualized and tailored to both patient- and disease-specific characteristics. Key management principles include (1) initial assessment and stabilization of the airway, (2) comprehensive clinical evaluation, and (3) formulation of a targeted treatment plan. As the prognosis of patients with nonmalignant CAO is rarely limited by the airway pathology itself, a definitive solution such as surgery is preferred over the typically temporary relief offered by therapeutic bronchoscopy. Moreover, inappropriate interventions can cause iatrogenic complications and even preclude surgical eligibility. Therefore, patients should always be evaluated for curative surgery where appropriate despite the availability of numerous bronchoscopic modalities. However, surgical feasibility may still be limited by other factors such as emergency presentation of CAO, patient preference for less invasive treatment, concomitant comorbidities that pose significant anesthetic risk, or the lack of surgical expertise. Finally, optimal management of nonmalignant central airway obstruction is best accomplished within a multidisciplinary framework.