Objective: To investigate the safety and efficacy of high-flow nasal cannula therapy（HFNC） versus noninvasive positive pressure ventilation（NIPPV） for patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and type II respiratory failure. Methods: We assigned patients with AECOPD and type II respiratory failure who were admitted to the Department of Respiratory and Critical Care Medicine in our hospital from June 2019 to March 2020 into HFNC group（35 cases） and NIPPV group（31 cases） according to the order of admission. All the patients were treated with conventional therapies（such as anti-infective treatment

anti-inflammatory treatment

and bronchodilators）

in addition to which the HFNC group received HFNC

while the NIPPV group received NIPPV. The response rate

failure rate

adverse events

and duration of respiratory support were compared between the two groups. Results: The two groups showed comparable basic conditions and clinical and laboratory indicators. There were no significant differences in the response rate and failure rate between the HFNC group and NIPPV group. The duration of respiratory support of the HFNC group was significantly longer than that of the NIPPV group（t = 2.446

P = 0.018）. Compared with the NIPPV group

the HFNC group had significantly less frequent adverse events（χ2 = 44.201

P = 0.000）

showing a superiority in facial pressure injury and implications for swallowing function. Conclusion: HFNC is equal to NIPPV on respiratory support in patients with AECOPD and typeⅡ of respiratory failure

HFNC had less adverse events

safe and effective

so HFNC may be recommended for clinical application.