OBJECTIVE： To observe the clinical efficacy and safety of tiotropium bromide combined with Salmeterol fluticasone aerosol in the treatment of severe COPD in elderly patients. METHODS： A total of 90 elderly patients with severe COPD selected from May 2013 to May 2015 in our hospital as research objects were divided into control group and observation group according to random number table， with 45 cases in each group. Control group was given Salmeterol xinafonate and fluticasone propionate aerosol 1 press/time， bid； observation group was additionally given Tiotropium bromide powder for inhalation 18 μg， qd， on the basis of control group. Both groups were treated for 8 weeks. The short-term clinical efficacy， dyspnea score， pulmonary ventilation function indexes [FVC， EFV1， EFV1％]， blood gas analysis indexes [p（O2）， p（CO2）] and QLI score before and after treatment were observed in 2 groups. The re-hospitalization time and the occurrence of ADR were compared between 2 groups. RESULTS： The total response rate of short-term treatment in observation group was 97.78％， which was significantly higher than 80.00％ of control group， with statistical significance （P＜0.05）. There was no statistical significance in dyspnea scores， pulmonary ventilation function indexes， blood gas analysis indexes or QLI scores between 2 groups before treatment （P＞0.05）. After treatment， dyspnea scores and p（CO2） of 2 groups were decreased significantly， while pulmonary ventilation function indexes， p（O2） and QLI scores were increased significantly； the observation group was significantly better than the control group， with statistical significance （P＜0.05）. The re-hospitalization time of observation group was significantly less than that of control group， with statistical significance（P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups（P＜0.05）.  CONCLUSIONS： Tiotropium bromide assisted with Salmeterol fluticasone aerosol show significant therapeutic efficacy for elderly severe COPD， and effectively relieve dyspnea symptom， improve pulmonary ventilation function and quality of daily life， reduce the re-hospitalization risk and do not increase the incidence of ADR.