Abstract： Objective： To observe the clinical effect of Modified Qingqi Huatan Decoction combined with non-invasive positive pressure ventilation on patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods：A total of 130 patients with acute exacerbation of COPD and respiratory failure were randomly divided into a treatment group and a control group using a simplified method，with 65 cases in each group. The control group was treated with non-invasive positive pressure ventilation，while the treatment group was treated with a combination of Modified Qingqi Huatan Decoction on the basis of the control group. After 14 days of treatment，evaluate the clinical efficacy of two groups and compare the levels of lung function，arterial blood gas indicators，serum monocyte chemotactic protein-1 (MCP-1)， and soluble myeloid cell trigger receptor-1 (sTREM-1) before and after treatment. Results： After treatment， the total effective rate of the treatment group was 96.92%， higher than the control group's 87.69% (P＜0.05). After treatment， the forced vital capacity (FVC)， forced expiratory volume (FEV1) in the first second，and the percentage of FEV1 to the expected value (FEV1%) in both groups were increased (P＜0.05)， and the treatment group was higher than the control group (P＜0.05). After treatment，the arterial blood pH and partial pressure of oxygen (PaO2) in both groups were increased (P＜ 0.05)， while partial pressure of carbon dioxide (PaCO2) were decreased (P＜0.05). Moreover， the PaO2 in the treatment group was higher than that in the control group (P＜0.05)，and the PaCO2 was lower than that in the control group (P＜0.05). After treatment， the levels of MCP-1 and sTREM-1 in both groups were decreased (P＜0.05)， and the treatment group was lower than the control group (P＜0.05). Conclusion： The use of Modified Qingqi Huatan Decoction combined with non-invasive positive pressure ventilation has a significant therapeutic effect on patients with acute exacerbation of COPD and respiratory failure. It can improve lung function，arterial blood gas indicators，and alleviate inflammatory reactions.