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Direct answer
Great clinical question. In acute hypercapnic COPD, the primary problem is alveolar hypoventilation — not just low O₂. Supplemental oxygen alone can blunt the hypoxic drive and worsen CO₂ retention (Haldane effect). BiPAP supports each breath with IPAP/EPAP, directly offloading the work of breathing and driving down PaCO₂.
NBRC practice question
A COPD patient on 4 L/min NC has: pH 7.31 | PaCO₂ 61 | PaO₂ 64 | HCO₃⁻ 30 | SpO₂ 91%. They are awake with mild accessory muscle use and pursed-lip breathing. What is the best next intervention?