Objective To investigate the effects of budesonide-eucalyptus pinane dual regimen on symptom control, oxygenation status and lung function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to provide a reference for optimizing the clinical treatment protocol. Methods The clinical data of 84 AECOPD hospitalized patients admitted to the Department of Respiratory and Critical Care Medicine, Longyan First Hospital Affiliated to Fujian Medical University from June 2024 to March 2025 were retrospectively analyzed, and all the patients were divided into the control group and the observation group according to the difference in the treatment protocols (both n=42). The control group received conventional treatment plus budesonide nebulized inhalation treatment, and the observation group received eucalyptus-pinane enteric capsule orally on the basis of the control group, and both groups were treated for 14 days. The COPD Assessment Test (CAT) score, modified MRC (mMRC) score, lung function indexes [Forced Expiratory Volume in 1 second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC], arterial blood gas parameters [Partial pressure of oxygen (PaO2), Partial Pressure of Carbon Dioxide (PaCO2), Oxygen Saturation (SpO2)] and the incidence of adverse reactions were compared between the two groups before and after treatment. Results Both groups showed a significant decrease in CAT and mMRC scores after treatment compared with those before treatment, with greater improvement in the observation group (both P<0.05). In terms of lung function, improvement in FEV1, FVC and FEV1/FVC was significantly greater in the observation group than in the control group (all P<0.05). Similarly, the magnitude of the increase in PaO2 and SpO2 and the decrease in PaCO2 in the observation group was significantly higher than that in the control group (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05), and both groups had a good safety profile. Conclusion The budesonideeucalyptus pinane dual regimen can effectively alleviate respiratory symptoms, improve lung function and oxygenation status in AECOPD patients in a multidimensional manner, and has a good safety profile, which has a high value for clinical promotion.