Is neural drive the missing piece in the puzzle of COPD exacerbation?

The decision to discharge in patients affected by acute exacerbation of COPD remains a common problem due to the complexity of the assessment of clinical recovery, with early readmission perceived as a marker of incompleteness of the received treatment. The neural respiratory drive, assessed by parasternal muscle electromyography, represents an estimate of the load imposed to the respiratory muscles and it may identify early clinical deterioration. The test is noninvasive, may be executed bedside, but requires experienced operators. Yet, feasibility and clinical interpretation outside reference centers seem to be the main unsolved issues in the implementation of the technique in clinical practice.