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COPD Acute Respiratory Failure — RACP Adult Medicine MCQ

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EasyRespiratoryCOPD Acute Respiratory FailureRACP Adult Medicine

A 72-year-old man with chronic obstructive pulmonary disease presents with a PaCO₂ of 75 mmHg and pH 7.25 on arterial blood gas. He is drowsy but rousable. What is the most appropriate ventilatory support?

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Correct answer: E — Non-invasive ventilation (BiPAP)

Acute hypercapnic respiratory failure in COPD (pH <7.35, PaCO₂ >45 mmHg) is an indication for non-invasive ventilation (NIV/BiPAP). NIV reduces intubation rates, length of stay, and mortality. It should be commenced early when pH <7.35. Contraindications include haemodynamic instability, inability to protect airway, facial trauma, or GCS <8. If NIV fails (worsening pH or consciousness), invasive ventilation should be escalated. The COPD-X guidelines strongly recommend early NIV.

Reference: Lung Foundation Australia/TSANZ – 2025 – COPD-X Plan; BTS/ICS – 2016 – NIV Guidelines