High Flow Nasal Oxygen for Exacerbation COPD

This study compares two breathing support treatments for patients experiencing a severe COPD flare-up (exacerbation) where carbon dioxide is building up in the blood: high-flow nasal oxygen versus non-invasive ventilation (a breathing mask). The goal is to determine which approach is safer and more effective. **You may be eligible if...** - You have a known diagnosis of COPD - You are having an acute flare-up where your carbon dioxide level is elevated (above 45 mmHg) and your blood is slightly acidic (pH 7.20-7.35) - You are older than 40 **You may NOT be eligible if...** - You have asthma (not COPD) - You need immediate intubation (a breathing tube) - You already use home breathing support equipment (BiPAP, CPAP) or are known to need it - You have cognitive impairment, dementia, or active serious psychiatric illness - You have a heart attack, severe heart failure, or large pulmonary embolism at the same time - You have a tracheostomy - You are already enrolled in another interventional trial Talk to your doctor to see if this trial is right for you.