Conflict of interest: P.J. Wijkstra has received remuneration for giving lectures. Financial support: none declared.

• Over the last 20 years the number of Dutch patients on home mechanical ventilation has increased from 200 to 2000.

• Home mechanical ventilation is a cost-effective treatment which significantly improves the quality of life of patients.

• In 2011 83% of patients on home mechanical ventilation in the Netherlands is living at home.

• In the future further growth can be expected in the number of patients with obesity hypoventilation syndrome and a potential new group of patients with COPD.

• Strict conditions are necessary to ensure safety in the complex care that home mechanical ventilation entails.