Most patients respond well to therapy.
However, a small minority will show signs of worsening ventilation, whether from worsening airflow obstruction, worsening respiratory muscle fatigue, or a combination of the two. The Expert Panel recommends that intubation not be delayed once it is deemed necessary . Because respiratory failure can progress rapidly and can be difficult to reverse, early recognition and treatment are critically important. Intravenous administration of a beta 2 -agonist also falls into this category of unproven treatment. There are no other absolute indications for endotracheal intubation, but persistent or increasing hypercapnia, exhaustion, and depression of mental status strongly suggest the need for ventilatory support.