A 68-year-old woman with COPD presents with acute dyspnea and confusion. Arterial blood gas shows pH 7.25, PaCO₂ 68 mmHg, HCO₃⁻ 30 mEq/L, and PaO₂ 52 mmHg. What is the most common cause of respiratory acidosis in COPD exacerbations?

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