Objective To explore the clinical efficacy and application value of fiberoptic bronchoscopy bronchoalveolar lavage (BAL) + ambroxol hydrochloride in the treatment of patients with pulmonary infection after stroke. Methods A retrospective study was conducted on 92 patients with post-stroke pulmonary infection who were treated in our hospital from March 2021 to January 2024. They were divided into a control group of 46 patients (BAL) and an observation group of 46 patients (BAL + ambroxol hydrochloride) based on the treatment plan.The clinical efficacy and adverse reactions of the two groups were compared, as well as the degree of dyspnea before and after treatment, the St. George"s Respiratory Questionnaire (SGRQ) score, the Clinical Pulmonary Infection Score (CPIS), lung function [peak expiratory flow rate (PEF), forced expiratory volume in 1 s (FEV1), maximum voluntary ventilation (MVV), FEV1/forced vital capacity (FEV1/FVC)], inflammatory factors [procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6)]. Results The total effective rate of the observation group was 95.65%, which was higher than that of the control group (80.43%) (P<0.05). The scores of mMRC and CPISS in the observation group after treatment were (1.85±0.19) and (3.45±0.85), respectively, which were lower than those in the control group (2.46±0.32) and (4.83±0.77), respectively, the scores of SGPQ were (41.03±4.16), (39.65±4.31), and (31.06±3.22), respectively, which were lower than those in the control group (56.74±5.31), (52.17±4.16), and (45.31±4.19), respectively (P<0.05). The PEF, FEV1, MVV, and FEV1/FVC in the observation group after treatment were (8.74±1.17) L/s, (2.56±0.25) L, (89.63±5.51) L/min, and (66.54±3.36) %, respectively, which were higher than those in the control group (7.65±1.06) L/s, (2.13±0.33) L, (75.54±6.03) L/min, and (57.01±4.52) % (P<0.05). The levels of serum PCT, CRP, and IL-6 in the observation group after treatment were (0.93±0.15) mg/L, (10.21±2.40) mg/L, and (17.24±3.74) pg/mL, respectively, which were lower than those in the control group (1.33±0.20) mg/L, (19.52±3.50) mg/L, and (28.36±5.54) pg/mL (P<0.05). There were no significant adverse reactions in both groups. Conclusion The treatment of BAL+ambroxol hydrochloride for patients with pulmonary infection after stroke is effective, which can improve dyspnea symptoms, protect lung function, improve quality of life, inhibit inflammatory reactions, and has certain safety.