A patient with COPD exacerbation presents with drowsiness, ABG shows pH 7.28, PaCO₂ 65 mmHg. Best immediate management?

Correct option is B

COPD exacerbation with type II respiratory failure (hypercapnia + acidosis) is best managed initially with non-invasive ventilation (BiPAP).
Explanation of options: (a) ✘ Intubation only if NIV fails or patient unstable. (b) ✔ Correct; BiPAP improves ventilation, avoids intubation. (c) ✘ High-flow oxygen worsens CO₂ retention; give controlled O₂. (d) ✘ Bicarbonate not indicated; main issue is CO₂ retention.