〔Abstract〕 Objective To explore the effect of fine airway nursing combined with Cox health behavior interaction mode on the application and respiratory function of elderly patients with ventilator-associated pneumonia. Methods Seventy cases of elderly patients with ventilator-associated pneumonia admitted to Henan Provincial People's Hospital from January 2020 to December 2022 were selected as the study subjects, and all the patients were divided into an observation group and a control group by the method of randomized numerical table, with 35 cases in each group. The control group implemented routine care, and the observation group added airway refinement care combined with Cox health behavior interaction model on the basis of the routine care, the quality of care of the two groups of patients respectively were assessed and compared, and the changes in respiratory function before and after care and the incidence of negative events were compared. Results The total scores of nursing quality management, nursing document quality, emergency nursing quality, special nursing quality, disinfection and isolation quality and nursing quality in the observation group were significantly higher than those in the control group, with statistical significances (P < 0.05). There were no significant differences in forced expiratory volume in one second (FEV1), forced vital capacity(FVC), FEV1/FVC and peak expiratory flow (PEF) between the two groups before the intervention (P > 0.05). After the intervention, the levels of FVC, FEV1, FEV1/FVC and PEF of the two groups were increased, and these indexes in the observation group were higher than those in the control group (P < 0.05). The total incidence of negative events in patients in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion The application of airway refinement care combined with Cox health behavior interaction model in elderly patients with ventilator-associated pneumonia is effective in improving the quality of clinical care, further improving patients' respiratory function, and having a low incidence of negative events.