It has been shown that overall, the greater the severity of COPD the greater the associated cost, with increased costs associated with severe disease.  Severe COPD exacerbations usually present to the hospital with respiratory failure or respiratory distress.  When these patients are assessed in the emergency room (ER), if they are stabilized but their symptoms have not completely resolved, they are usually admitted to the hospital for ongoing treatment.  However there is a subset of these patients who go on to full respiratory failure and may require invasive or noninvasive ventilation (NIV) and admittance to the intensive care unit (ICU).  As seen from statistics from the American Hospital Association (AHA),^[5] medical and specialized respiratory care units, critical care units, and ICUs are all high-cost centers.