Objective To investigate the effects of budesonide formoterol powder inhalation on oxidative stress and thoracic lung compliance in patients with the acute attack stage of chronic obstructive pulmonary disease (COPD). Methods A total of 110 patients with the acute attack stage of COPD in General Hospital of Hebi Coal Industry Group Co., Ltd. from October 2022 to October 2024 were divided into 2 groups. In the conventional group, 55 patients received tiotropium bromide powder inhalation and non-invasive mechanical ventilation and other conventional treatments. In the study group, 55 patients were treated with budesonide formoterol powder inhalation on the basis of the conventional group. The thoracic lung compliance, respiratory dynamics, pulmonary function and serum oxidative stress molecular level and adverse reactions between the two groups were compared before and after 1 week of treatment. Results Chest wall compliance (CTh), lung compliance (CI), total compliance (Ct) and peak airway pressure (PIP) after 1 week in the study group were higher than those of the conventional group, and the airway resistance (Raw) and mean airway pressure (MPaw) were lower than those of the conventional group (P < 0.05). After 2 weeks of treatment, forced vital capacity(FVC), forced expiratory volume in the first second (FEV1), superoxide dismutase (SOD), catalase (CAT) and FEV1/FVC in the study group were higher than those of the conventional group, and malondialdehyde was lower than that of the conventional group (P < 0.05). There was no significant difference in total adverse reactions between the two groups (P > 0.05). Conclusion Budesonide formoterol powder inhalation can improve the respiratory dynamics and thoracic lung compliance of patients with the acute attack stage of COPD, and promote the improvement of oxidative stress and pulmonary function.