Chronic respiratory failure following an acute exacerbation of COPD is associated with excess morbidity and mortality and, empirically, the use of long-term non-invasive ventilation (NIV) to treat the chronic respiratory failure to improve outcome is a rational therapeutic option.

Although detailed physiological studies have demonstrated a reduction in the arterial pCO2 by managing sleep disordered breathing and enhancing sleep quality, previous randomised controlled trials have failed to translate physiological improvement into a clinical benefit.

Despite the lack of clinical trial evidence supporting the addition of NIV to standard treatment, including long-term oxygen therapy, there has remained widespread clinical enthusiasm in the UK and Europe for the use of home mechani...