Aims and background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are significant contributors to type II respiratory failure, often necessitating interventions like noninvasive ventilation (NIV). This audit aimed to evaluate the utility of NIV following the British Thoracic Society (BTS) guidelines in managing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and OSA patients with type II respiratory failure. Methods: A total of 67 adult patients were recruited and assessed using vital parameters, arterial blood gas (ABG) reports, and clinical examinations. NIV was initiated based on BTS guidelines, and patients were monitored for response and tolerability. Data collection included demographics, comorbidities, NIV settings, and outcomes. Results: Among the patients, 92.5% had AECOPD, and 7.5% had OSA with type II respiratory failure. Initial NIV settings (12/6) resulted in improvement in blood gas parameters and clinical status for 75% of patients, while others required increased settings (14/7). Seven patients failed NIV and required mechanical ventilation, while 60 patients showed significant improvement over 24 hours. Conclusion: NIV, as per BTS guidelines, has demonstrated efficacy in managing AECOPD and OSA patients with type II respiratory failure. Clinical improvement and optimal blood gas parameters were observed in a majority of cases, highlighting the importance of NIV as an initial choice before invasive ventilation. Clinical significance: The study underscores the importance of adhering to guidelines in NIV management for respiratory failure cases, leading to improved patient outcomes and reduced need for invasive ventilation. This approach can be particularly beneficial in resource-limited settings and may have implications for COVID-19 management as well.