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Acute exacerbations of chronic obstructive airways disease (COAD) are a common cause of admission to hospital, and have a high mortality. Nasal intermittent positive pressure ventilation (NIPPV) has been used successfully in patients with respiratory failure due to neuromuscular and skeletal disorders, but the outcome of treatment in patients with COAD is less well known. We carried out a prospective randomised controlled trial of conventional treatment versus conventional treatment plus NIPPV, in 60 patients with acute ventilatory failure due to exacerbations of COAD. For the NIPPV group there was a rise in pH, compared with a fall in the controls (mean difference of change between the groups 0·046 [95% Cl 0·06-0·02, p<0·001]), and a larger fall in PaCO₂ (mean difference in change between the groups 1·2 kPa [95% Cl 0·45 to 2·03, p<0·01]). Median visual analogue scores over the first 3 days of admission …