Nationwide from 2000-2009, there was a steady increase in the use of noninvasive ventilation (NIV) in managing acute respiratory failure, although the percentage of potentially eligible patients who receive it remains small. Importantly, the proportional increase was less for chronic obstructive pulmonary disease ([COPD] in which the evidence is compelling and NIV is the standard of care) than for non-COPD causes of respiratory failure (in which the evidence is weaker or conflicting).