Abstract： Objective： To observe the clinical effect of Chinese medicine point application combined with phlegm-heat clearing atomization on chronic obstructive pulmonary disease (COPD) complicated with severe pneumonia and its effect on toll-like receptor 4 (TLR4) mRNA and mucins 5AC (MUC5AC). Methods： A total of 98 cases of COPD patients complicated with severe pneumonia were divided into the control group and the observation group，with 49 cases in each group，using a random number table method. The control group received routine symptomatic treatment， and the observation group received additional treatment with Chinese medicine point application combined with phlegm-heat clearing atomization in addition to the treatment of the control group. The acute physiology and chronic health evaluationⅡ(APACHE Ⅱ) scores，traditional Chinese medicine (TCM) syndrome scores，lung ventilation function indicators，and TLR4 mRNA and MUC5AC levels were compared before and after treatment between the two groups. The clinical effects and incidence of adverse reactions were evaluated in both groups. Results： The total effective rate was 95.92% in the observation group，which was higher than that of 79.59% in the control group (P＜0.05). After treatment，the maximum ventilation volume (MVV)，peak expiratory flow rate (PEF) levels， first second forced expiratory volume (FEV1)， forced vital capacity (FVC)， and FEV1/FVC in both groups were increased when compared with those before treatment (P＜0.05)， and APACHE Ⅱscores， TCM syndrome scores， TLR4 mRNA， and MUC5AC levels were decreased when compared with those before treatment (P＜0.05)； the observation group had lower APACHE Ⅱ scores， TCM syndrome score， and TLR4 mRNA and MUC5AC levels than the control group (P＜0.05)，and higher lung ventilation function indicators levels (P＜0.05). No serious adverse reactions were observed in the two groups. Conclusion： Chinese medicine point application combined with phlegm-heat clearing atomization has a significant curative effect in treating COPD complicated with severe pneumonia，which can regulate TLR4 mRNA and MUC5AC levels in patients，and improve lung ventilation function，with high safety.