Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: “Don't Think Twice, It's Alright!”

NIV has become both the “gold standard” and “standard of care” for most patients with an acute exacerbation of COPD of sufficient severity to require ventilatory support. Important challenges remain in the ongoing education and training of healthcare workers responsible for the prescription and delivery of NIV. The respiratory community needs to determine the most appropriate response when patients develop acidosis during their admission or deteriorate despite NIV. For some patients escalation in therapy is the right response, but for others a move to a more palliative approach is more appropriate.