Trethewey SP, et al. - In this retrospective analysis, researchers assessed in-hospital mortality in COPD patients in relation to time from hospital presentation to diagnosis of acute hypercapnic respiratory failure (AHRF). Participants were recruited from a large UK teaching hospital from 2004 to 2017, and included hospitalised COPD patients treated with a first episode of ward-based non-invasive ventilation (NIV) for AHRF. Overall 547 patients were included, with 245 males (44.8%), having median age 70.6 years and median FEV1% predicted 34%. AHRF >24 h after hospital presentation, pneumonia on admission, increased age and NIV as ceiling of treatment were all identified as significant predictors of in-hospital mortality in multivariable logistic regression. Overall, they concluded that increased in-hospital mortality may be seen among hospitalised COPD patients with late presentation of AHRF, needing acute ward-based NIV. Closer monitoring and earlier specialist respiratory review could be beneficial for these patients.