Objective To investigate the clinical predictors of increased FeNO level in Tibetan acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods The Tibetan AECOPD patients admitted to 363 Hospital from June 2018 to February 2023 were included in this study. FeNO levels, demographic characteristics, living environment, personal history, family history, lung function, and blood test indexes of the patients were collected. The Tibetan AECOPD patients were divided into high FeNO group (FeNO>25ppb) and low FeNO group (FeNO≤25 ppb) as according to the cut-off value 25 ppb. The variables with statistical differences between the high and low FeNO groups and the variables significantly related to FeNO in previous studies were further weighted by generalized propensity scores to evaluate the degree of association with FeNO levels. Results A total of 235 Tibetan patients with AECOPD were included in this study, with 71 patients included in the high FeNO group (30.2%) and 164 patients included in the low FeNO group (69.8%).Compared with the patients of the low FeNO group, patients of the high FeNO group had a longer period of biomass exposure (P<0.001), a higher proportion of current users of biomass (P<0.001), higher levels of eosinophils (P=0.040) , lower CRP levels (P=0.045), lower proportion of current smokers (P=0.011) and living at a relative lower altitude (P=0.016). The weighted (generalized) propensity scores further indicated that the Tibetan AECOPD patients of high FeNO level had higher peripheral blood EOS counts (P=0.032), higher stature (P=0.016), older age (P=0.037), higher proportion of current users of biomass (P<0.001), lower proportion of current smokers (P=0.011) and living at a relative lower altitude (P=0.016). Conclusion This study found that in Tibetan AECOPD patients, biomass exposure, increased blood EOS cell count, older age, taller population, but not current smoking and higher living altitude, may be considered as clinical predictors of high FeNO levels