Objective To analyse the prognosis and risk factors of lung cancer with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Tongchuan City, and to provide a theoretical basis for improving the prognosis of patients with lung cancer complicated with AECOPD. Methods A total of 280 patients with lung cancer combined with AECOPD admitted to Tongchuan People's Hospital from January 2021 to August 2022 were selected and divided into survival group and death group according to whether the patients survived during hospitalization. Serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-1) and other tumor markers were compared between the two groups. Lung function was measured by lung function instruments, and the levels of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC and other lung function indicators were compared between the two groups. The patients' clinical data were collected from the medical record system, and univariate analysis and logistic regression were used to analyze the independent risk factors affecting the prognosis of patients with lung cancer complicated with AECOP. Results The values of FEV1, FVC and FEV1/FVC in the death group were significantly lower than those in the survival group (P<0.05). Serum CEA and CYFRA 21-1 levels in the death group were significantly higher than those in the survival group (P<0.05). Multiple logistic regression analysis showed that albumin level <35 g/L (OR=2.728), TNM stage III to IV (OR=2.416), multidrug-resistant bacterial infection (OR=2.982), and GOLD grade III to IV (OR=3.417) were independent risk factors for death in patients with lung cancer complicated with AECOPD in Tongchuan City (P<0.05). Conclusion Patients with lung cancer complicated with AECOPD in Tongchuan City have a high risk of death during hospitalization, especially patients with TNM stage III to IV and GOLD grade III to IV. Multi-drug resistant bacteria infection should be actively controlled to improve the albumin level of patients, which is conducive to the prognosis of patients.