Bräunlich J, et al. - Using a multi-centered, randomized, controlled, cross-over design, researchers compared noninvasive ventilation (NIV) to nasal high-flow (NHF) in terms of efficacy in COPD patients with stable, chronic hypercapnia recruited from 13 German centers. Between 2011 and 2016, patients were treated with 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO). Randomization was done including 102 patients with (mean±SD) age 65.3±9.3 years, body mass index of 23.1±4.8 kg/m², 90% were GOLD D, pCO₂ was 56.5±5.4 mmHg and 61% were females. From baseline, a reduction in PCO₂ levels by 4.7% and by 7.1% occurred using NHF and NIV, respectively. As far as pCO₂ attenuation and improvement in quality of life were concerned, the possible role of NHF as an alternative to NIV was suggested in COPD patients with stable chronic hypercapnia, eg, those not tolerating or rejecting NIV.