▪ The present study was conducted to understand the role of NIPPV in patients with acute exacerbation of COPD who are medically unresponsive. The sample size was 40. ▪ The mean age of the study population was 60.7± 7.2 yrs. ▪ Out of the 40 cases included in the study, 36 (90%) were males and 4 (10%) were females, sex ratio 9:1(male:female). ▪ A history of smoking was obtained in 90% of study population. ▪ The Borg dyspnoea score improved from 5 at baseline to 1.4 ± 0.07 at discharge. (p <0.0001) ▪ The mean respiratory rate dropped from 34.8 ± 4.4 before NIV to 13.82 ± 1.96 (p <0.0001) at discharge. Heart rate too decreased from 102.4 ± 10.9 to 77.1 ± 9.65(p <0.0001). ▪ The mean pH changed from 7.29± 0.02 at baseline to 7.4 ±0.03 at discharge (p <0.0001). ▪ There was also a marked improvement in mean PaCO2 and PaO2 which changed from, 67.3 ± 5.61, 54.6 ± 8.85 at baseline to 50.02 ± 4.08, 75.1 ± 9.71 at the time of discharge respectively (p<0.0001 for both parameters). ▪ Respiratory rate at baseline was significantly higher in the patients who failed to respond to NIV and there was a significant improvement in the clinical and blood gas parameters within the 1st of NIV in the successful group whereas no such improvement was observed in the failure group. ▪ In the present study NIPPV was successful in 34 patients (85%) and 6 patients (15%) failed to respond and required intubation. Of them, 2 patients did not consent and left against medical advice. 4 were intubated and all of them eventually expired. No mortality was observed in the patients improved and continued on NIPPV. ▪ The mean IPAP used in the present study was 16.5 ± 0.9 and mean EPAP used was 5.2±0.52. ▪ NIPPV was used for an average of 38.5±13 hrs. ▪ The incidence of complications in the present study was 10% which included aspiration pneumonia (2.5%), irritation of eyes (5%) and dryness of mouth (2.5%). ▪ The mean duration of hospital stay in the present study was 10.32±3.46 days. Our results strongly support and encourage the use of NIPPV as a first line ventilatory management in patients with respiratory failure due to acute exacerbations of COPD.