Acquired DP in adults is multifactorial. Symptoms largely depend on whether or not the paresis is unilateral or bilateral and on the etiology, onset, progression, and presence of underlying pulmonary disease. UDP is a well-tolerated condition with a favorable prognosis. Diaphragmatic plication is indicated in carefully selected patients with UDP and can be done by minimally invasive techniques. Patients with BDP are usually severely symptomatic and require some form of mechanical ventilatory support. Diaphragmatic pacing is an option for a select group of patients with BDP in centers with specialized expertise.