In summary, from my clinical experience with severe COPD patients who were prescribed NIV outpatient treatment and monitored closely, with frequent contact with their respiratory therapist, I get frequent downloads and communication from the patients and frequent follow-up to ensure adherence.  As a result I have seen that in my patient population, those who are compliant have fewer readmissions, and the patients who are not as compliant have more readmissions.  Clearly a very important part of the care that is provided for COPD patients is the patient education and the contact between the caretakers and the specialists.  From my experience, NIV does decrease the rate of readmissions in my patient population, and I look forward to the prospective studies down the road.