Treatment of respiratory failure in the patient with chronic obstructive lung disease requires the use of a controlled oxygen, treatment of reversible causes of deterioration, and treatment of the associated bronchospasm. Complications such as pulmonary emboli and gastrointestinal bleeding should be avoided by prophylactic therapy. Mechanical ventilation should be avoided if possible. If the patient requires intubation, weaning and extubation should be an orderly transition to spontaneous ventilation. Nutritional support should be stressed during respiratory failure. Finally, as explained in detail in other chapters, a comprehensive outpatient treatment program should be planned prior to discharge from the hospital. A comprehensive approach to management should improve the quality of life and further improve survival in the patient with chronic obstructive lung diseases.