Beltaief K, et al. - In this double-blind controlled trial, researchers examined the influence of combining ipratropium bromide (IB) to terbutaline on hospital and intensive care unit (ICU) admission rates compared to terbutaline alone in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hypercapnic patients. They randomized patients who were admitted to the Emergency Department (ED) for AECOPD requiring noninvasive ventilation (NIV) to receive either 5 mg of nebulized terbutaline combined to 0.5 mg of IB or 5 mg of terbutaline sulfate. Outcomes suggest that patients admitted to the ED for AECOPD requiring NIV display no reduction in hospital admission and need to ICU care with the combination of nebulized IB and terbutaline.