Objective To explore the value of detecting exhaled nitric oxide(FeNO)during systemic glucocorticoid use in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A randomized controlled study was conducted from January 2019 to December 2021 at the People's Hospital of Meizhou City. The subjects were 58 AECOPD patients,all of whom were tested for FeNO levels. Based on whether the FeNO levels were>25 ppb,they were divided into a high level FeNO group and a low level FeNO group. They were divided into a treatment group and a control group based on whether they received systemic glucocorticoid therapy. The control group received routine treatment,while the treatment group received routine and systemic glucocorticoid therapy. Changes in FeNO and lung function indicators before and after treatment were detected,COPD assessment test(CAT)scores were determined,and differences between groups were compared. Results After systemic glucocorticoid therapy,the high level group of FeNO showed a decrease in FeNO(P<0. 05),while the high level group showed no statistically significant difference in FeNO before and after routine treatment(P>0. 05). The low level group showed no statistically significant difference in FeNO between the treatment group and the control group before and after treatment(P>0. 05). The first second forced expiratory volume(FEV₁)and the ratio of first second forced expiratory volume to forced vital capacity(FEV₁/FVC)in the high level group of FeNO significantly increased after treatment,and the degree of increase in the treatment group was greater than that in the control group(all P<0. 05). The FEV₁ and FEV₁/FVC in low level group of FeNO significantly increased after treatment(all P<0. 05),but the difference between the treatment group and the control group was not significant(P>0. 05). The CAT scores of the high and low levels of FeNO groups decreased after treatment compared to before treatment(all P<0. 05),and the decrease was more significant in the high level FeNO group. Conclusions The implementation of FeNO measurement in AECOPD patients can reflect airway inflammation to a certain extent,predict glucocorticoid treatment response,guide the rational and effective application of systemic glucocorticoid and avoid excessive glucocorticoid use.