This study retrospectively analyzes the impact of smoking on the composition ratio of respiratory pathogens and their drug sensitivity results in lung cancer patients with concurrent pneumonia. It aims to provide a theoretical basis for the selection of antibiotics in the clinical treatment of lung cancer patients with concurrent pneumonia.The study collected clinical data from hospitalized patients diagnosed with lung cancer and concurrent pneumonia from January 2018 to December 2022. Information on lung cancer patients with positive respiratory pathogen cultures was obtained, and a retrospective analysis of their clinical cases was conducted to assess their smoking status. The patients were then divided into smoking and non-smoking groups for comparison, and the composition ratio of respiratory pathogens and differences in drug sensitivity results were analyzed. Among the 287 lung cancer patients with concurrent pneumonia, the sputum culture results in the smoking group showed a significantly higher detection rate of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus (P<0.05). However, the detection rate of Staphylococcus epidermidis was lower in the smoking group compared to the non-smoking group. There were no statistically significant differences between the smoking and non-smoking groups in the detection of Acinetobacter baumannii, Enterobacter cloacae, Pseudomonas putida, Burkholderia cepacia, Burkholderia gladioli, and Burkholderia pseudomallei. The detection rate of Candida albicans was higher in both groups, with a significantly higher detection rate in the smoking group (P<0.05). There were no significant differences between the smoking and non-smoking groups in the detection of Cryptococcus neoformans and Candida tropicalis. Additionally, there were no significant differences in the drug resistance rates of Pseudomonas aeruginosa to commonly used antibacterial drugs between the smoking and non-smoking groups.Smoking can lead to changes in the respiratory pathogen profile of lung cancer patients, promoting colonization of certain pathogenic bacteria and contributing to the occurrence of pneumonia. Smoking can also lead to an increased drug resistance rate of respiratory pathogens in lung cancer patients with concurrent pneumonia.