The association between nutritional depletion and chronic respiratory disease is well known. During exacerbations of respiratory disease, pulmonary function can be impaired to a level that negatively impacts an individual’s ability to achieve their nutritional requirements [5]. The etiology of nutritional depletion in this instance is multifactorial and a combination of an inability to achieve altered nutritional requirements against a background of elevated systemic inflammation, impaired functional capacity, and medication side effects [5]. Although medical interventions such as NIV can serve as an additional physical barrier to the intake of food, NIV has been shown to be associated with an improvement in nutritional status in those previously identified as at nutritional risk [6]. Budweiser and colleagues [6] acknowledged the complexity of weight loss in COPD and speculated that NIV could assist in producing a positive nutritional balance required for weight gain through reducing the work associated with breathing. Similar improvements in body weight have also been reported following lung volume reduction surgery [5, 6]. It is also feasible that NIV results in improved nutritional status through other mechanisms such as improvement of hypercapnia and acidosis, which are known to negatively impact protein synthesis [6]. Elevated systemic inflammation, particularly during acute episodes of the disease, is known to negatively impact on appetite, nutrition intake, and protein synthesis and breakdown [5, 6]. As NIV assists in reducing episodes of respiratory failure, hypoxia, and elevated inflammation, this may reduce periods of negative energy balance and catabolism [6]. Acute exacerbations that did not involve the use of NIV have been associated with reduced nutritional intake and increased energy expenditure in COPD patients [7]. There is limited research describing nutritional intake of hospitalized patients receiving NIV, with no protocols currently available to guide health-care professionals in the nutritional management of this patient group. One prospective study of 36 hospitalized patients receiving NIV showed that more than 75 % of the patients had inadequate intake [8]. Intake was lower with increasing time on NIV, and earlier during their hospital admission. Patients who were enterally fed received significantly more energy and protein than those who were receiving oral nutrition only [8].