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Background and Aims Elderly COPD patients often experience balance impairment and fear of falling, increasing fall risk and reducing quality of life. This study assessed the effects of Tai Chi combined with inspiratory threshold loading training (ITLT) on balance, fear of falling, and related outcomes in elderly COPD patients.Methods A single-blind randomized controlled trial was conducted with 120 elderly COPD patients recruited from a tertiary hospital. Participants were randomly assigned to three groups: (1) Combined Group (Tai Chi + ITLT, n=40), (2) Tai Chi Group (n=40), and (3) Routine Care Group (n=40). The intervention lasted 12 weeks, with sessions conducted three times weekly. Tai Chi sessions focused on 24-form simplified routines, while ITLT used threshold resistors set at 30% of maximal inspiratory pressure. Balance function was assessed using the Berg Balance Scale (BBS), fear of falling was measured using the Falls Efficacy Scale-International (FES-I). Exercise capacity was measured using the 6-minute walk distance (6MWD), and pulmonary function was evaluated using forced expiratory volume in 1 second (FEV1%). Data were analyzed using mixed-effects models and ANOVA.Results Post-intervention, the Combined Group demonstrated significant improvements compared to the other groups: BBS score increased by 8.2 ± 2.1 points (vs. 5.1 ± 1.8 in Tai Chi Group and 1.3 ± 0.9 in Routine Care Group, p<0.001), FES-I score decreased by 11.5 ± 3.2 points (vs. 7.4 ± 2.7 and 2.1 ± 1.4, p<0.001), 6MWD improved by 48.6 ± 12.4 meters (vs. 32.1 ± 10.2 and 15.3 ± 8.6, p=0.002), FEV1%: Increased by 6.8% ± 2.1% (vs. 3.2% ± 1.7% and 1.5% ± 0.9%, p=0.016).Conclusions The combination of Tai Chi and ITLT synergistically enhances balance function, reduces fear of falling, and improves exercise capacity in elderly COPD patients. This dual-modality intervention offers a clinically feasible strategy to mitigate fall risk and promote holistic rehabilitation.