In the absence of severe clinical signs requiring endotracheal intubation, non-invasive mechanical ventilation is the first-line treatment in patients with chronic respiratory insufficiency. For a patient with non-invasive support, the probability to avoid intubation is 2 or 3 times higher than for a patient initially treated by oxygen therapy alone. Oxygen therapy will remain the recommended approach for staff unfamiliar with non-invasive support. In chronic obstructive pulmonary disease (COPD) ventilated patients, keeping the intrinsic positive end-expiratory pressure to a minimum level decreases the risk of barotrauma. During exacerbation, in these patients, the 3 most often prescribed medications are inhaled bonchodilators, corticosteroids, and antibiotics. In addition to long term home oxygen therapy, the preventive measures include education of patients, pulmonary rehabilitation programs, and eventually routine use of ventilatory support in a home ventilatory setting.