AIMTo study the outcome and predictors affecting the mortality in COPD patients with acute exacerbation and respiratory failure following pharmacotherapy, non-invasive ventilation and invasive ventilation. MATERIAL AND METHODSForty patients with acute exacerbation of COPD admitted to the CCU for one year period were studied. Baseline clinical assessment, investigations, APACHE II, APACHE III and OSF scorings were done. RESULTSOut of 40 patients 24 responded to pharmacotherapy, of these 2 patients died due to other causes. Five patients were initiated on non-invasive ventilation of which 2 patient's required invasive ventilation. Remaining 11 patients required invasive ventilation on admission, of these 7 patients died. Mortality was 43.75%. Multivariate analysis was done and APACHE II and Alveolar-arterial oxygen gradient (A-a) DO2 were independent predictors of mortality. CONCLUSIONAlthough significantly high mortality was seen in mechanically ventilated patients (43.75%), the overall mortality in this study was 22.5% and hence it can be concluded that the results of aggressive treatment of acute respiratory failure in COPD patients is favourable.