The decision to move to a form of mechanical ventilation in patients with acute respiratory failure due to an acute exacerbation of COPD is influenced by expectations about survival and quality of life after discharge from the ICU. Physicians tend to be too pessimistic about the survival outcome of an ICU stay with invasive mechanical ventilation. The forced expiratory volume in 1 second (FEV1) is not an adequate prognostic parameter. In order to prevent undertreatment of patients with respiratory failure due to an exacerbation of COPD, knowledge of prognostic parameters and quality of life in these patients is very important. End of life care should be integrated into the standard care of COPD patients.