Background: Chronic obstructive pulmonary disease (COPD) is characterized by expiratory airflow limitation that is not fully reversible. Acute respiratory failure, altered mental status, and hemodynamic instability associated with acute exacerbations of COPD are commonly encountered and require careful management in the intensive care unit (ICU). Noninvasive and invasive ventilator support in conjunction with pharmacotherapy can be lifesaving, although mortality remains high. Aim: To investigate the mortality rate, characteristics and health-related quality of life of COPD patients admitted to Sri Shankaracharya Institute of medical sciences ICU and how the decision is made whether to use invasive or non-invasive intensive treatment of the newly admitted COPD patient in need of ventilator support. Material and Methods: 70 patients admitted to ICU, Sri Shankaracharya Institute of medical sciences were included in the study and their detailed data, including Health-Related Quality of Life (HRQL) was assessed at the time of discharge, 3 months and 6 months post-discharge. A questionnaire was distributed to concerned ICUs personnel to define decisive factors in making the choice between invasive and non-invasive ventilation. The collected data and answers were analysed. Results: 1.5-2% of all ICU admitted patients needed ventilation. The mean age of patients was 68 years and all were severely ill on admission, with high respiratory rates. There were more men than women. The short- and long term mortality was high despite intensive care treatment. The majority of patients were treated with Non-Invasive Ventilation (NIV) with a short hospital stay. NIV seems to be preferable to invasive ventilation at admission for short and long term benefits. The health-related quality of life of COPD patients after treatment in ICUs is lower than in the general population. However, it does not decline between 3 and 6 months after ICU discharge. At the end of 6 months, the HRQL is quite similar to that of COPD patients not treated on the ICU. Conclusions: Patients admitted to ICU for COPD are severely ill and have long term mortality despite ventilation and intensive care. NIV should be the first treatment modality after ICU admission and has short and long term benefits. Also, NIV doesn__ampersandsignrsquo;t increase mortality if failed. Health-related quality of life post-treatment is lower in such patients than the general population but similar to COPD patients not treated in ICU at 6 months post-discharge.