Objective To investigate the efficacy and compliance of home noninvasive positive pressure ventilation (NPPV) in the elderly patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Methods A total of 100 elderly COPD patients with respiratory failure who were discharged after treatment in our department from January 2016 to December 2017 were recruited in this study. They were randomly divided into observation group and control group, with 50 cases in each group. The patients in the control group were given routine treatment at home, including expectoration, clearance of respiratory tract, anti-spasmodic and anti-asthmatic drugs, anti-infection and long-term oxygen inhalation. While those of the observation group received home NPPV on the basis of all above treatments as the control group. During 1 year′s follow-up, hospitalization, quality of life (SF-36 scale), dyspnea (St. George′s questionnaire), 6-minute walking test (6MWT), pulmonary function, arterial blood gas indices,compliance and incidence of adverse events before and after treatment were recorded and compared between the 2 groups. SPSS statistics 21.0 was used to analyze the data. According to the data types, Student′s t test or Chi-square test was employed for comparison between the two groups. Results During the follow-up of 1 year, the length of hospital stay was a little bit longer [(14.32±3.41) vs (13.33±2.54)d, t=1.646, P>0.05], while the hospital costs were significantly larger [(21.2±2.6) ×10³ vs (15.7±1.5) ×10³ yuan, t=12.956, P<0.05] in the control group than the observation group. The quality of life score, dyspnea score, 6MWT, forced expiratory volume in one second (FEV1), partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide(PaCO₂) were significantly improved in the both groups after treatment (P<0.05). The observation group had more significantly improved above indicators when compared with the control group (P<0.05). During the treatment period, there were no significant differences in the incidence of adverse events [26.0%(13/50) vs 34.0%(17/50), P=0.383] and the incidence of poor compliance [24.0%(12/50) vs 34.0%(17/50), P=0.271] between the observation group and the control group. Conclusion For the elderly COPD patients with respiratory failure, home NIPPV is worthy of promotion on the basis of routine therapies, because it relieves the symptoms, improves quality of life, and reduces hospital costs.