Objective To explore the protective mechanism of inhaling ambroxol hydrochloride solution combined with airway clearance technology on airway remodeling and lung injury in severe artificial airway patients. Methods The subjects of this study were 85 severe nerve patients with tracheal catheters from Zhujiang Hospital of Southern Medical University and People's Hospital of South China Sea Economic Development Zone, all of whom had artificial airways established. The study period was from June 2021 to June 2023. According to the random drawing method, they were divided into control group and study group. 43 cases were included in the control group and 42 cases were included in the study group. Patients in both groups were treated with airway clearance technology. The control group was treated with intravenous ambroxol hydrochloride injection, while the study group was treated with inhaled ambroxol atomization inhalation. Both groups were treated for 7 days, and the therapeutic effect was statistically measured after 7 days. The time of mechanical ventilation, length of ICU stay, readmission or emergency department were compared between the two groups. The changes of cough intensity, secretion volume and viscosity before and after treatment were evaluated and compared between the two groups. The contents of C-reactive protein (CRP), serum amyloid A (SAA) and procalcitonin (PCT) before and after treatment were compared between the two groups. The contents of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in sputum of the two groups before and after treatment were compared. Arterial blood gas analysis was compared between the two groups. Results The mechanical ventilation time, ICU stay time, readmission or emergency department times in the study group were significantly lower than those in the control group, with statistical significance (P＜0.05). The scores of cough intensity in the study group at 2d, 3d, 4d, 5d and 6d after treatment were significantly lower than those in the control group, with statistical significance (P＜0.05), but there was no significant difference between the two groups at 7d after treatment (P＞0.05). The score of secretions on day 1, day 2 and day 5 after treatment in the study group was significantly lower than that of the control group, with statistical significance (P＜0.05), but there was no significant difference between the two groups on day 7 after treatment (P＞0.05). The scores of sputum viscosity in the study group at the 1st, 2d, 3d, 4d, 5d, 6d and 7d after treatment were significantly lower than those in the control group, with statistical significance (P＜0.05). After treatment, CRP, SAA and PCT in the study group were significantly lower than those in the control group, and the difference was statistically significant (P＜0.05). After treatment, the contents of MMP-9 and TIMP-1 in study group were significantly lower than those in control group, and the difference was statistically significant (P＜0.05). After treatment, PaCO2, HCO3 and FiO2 in the study group were significantly lower than those in the control group, with statistical significance (P＜0.05), while PaO2, SaO2 and OI in the study group were significantly higher than those in the control group, with statistical significance (P＜0.05). Conclusion Ambroxol hydrochloride solution for inhalation has a good effect on patients with severe artificial airway after airway clearance technology, which can help shorten the time of mechanical ventilation and ICU stay, improve prognosis, relieve symptoms such as cough and expectoration, and help delay airway remodeling, reduce lung injury and improve lung function