**Abstract**

In the past, treatment of acute exacerbations of obstructive disease refractory to medical treatment was invasive mechanical ventilation. As a result of technical improvements, extracorporeal techniques for carbon dioxide removal have aroused as an attractive option to avoid worsening respiratory failure and respiratory acidosis and potentially prevent, shorten the duration of invasive mechanical ventilation (IMV), and serve as rescue therapy in patients with exacerbation of COPD and asthma. In this review, we will present a comprehensive summary of the pathophysiological rationale and evidence of ECCO2R in patients with severe exacerbations of these pathologies.

**Keywords:** COPD, asthma, ECCO2R, invasive mechanical ventilation, noninvasive mechanical ventilation
