Objective To investigate the application value of Tri-Ball respiratory exerciser in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 86 AECOPD patients admitted in Gaochun People′s Hospital of Nanjing from June 2017 to June 2018 were recruited in this study. They were randomly divided into observation group (n=43) and control group (n=43). The observation group underwent breathing training with Tri-Ball respiratory exerciser device, while the control group accepted conventional pursed lips ventral breathing training. The pulmonary function indices [forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity (FEVI/FVC), and FEV1/expected], blood gas parameters [arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂)], 6-minute walking distance (6MWD) and results of COPD assessment test (CAT) were compared between 2 groups. SPSS statistics 16.0 was used for analysis. According to the data type, Student′s t test or Chi-square test was used for intergroup comparison. Results After the treatment, significant improvements were achieved in pulmonary function, results of blood gas analysis, 6MWD and CAT scores in both groups (P<0.01). But the observation group obtained significantly greater improvements in PaO₂ [(63.98±2.61) vs (62.12±1.69)mmHg], PaCO₂ [(47.47±3.17) vs (48.88±3.00)mmHg], 6MWD[(229.67±46.38) vs (222.23±46.31)m] and CAT scores [(19.53±4.44) vs (20.19±4.48)] when compared with control group (all P<0.05). Conclusion Tri-Ball respiratory exerciser is helpful to restore respiratory function and improve the quality of life in early pulmonary rehabilitation for elderly AECOPD patients.