Chronic obstructive pulmonary disease (COPD) and respiratory tuberculosis are important respiratory problems. Meeting together, these diseases can mutually worsen the severity of clinical manifestations and negatively affect prognosis. COPD and tuberculosis share a number of common risk factors and pathogenetic mechanisms involving various immune and non-immune cells. Inflammation, hypoxia, oxidative stress, and lung tissue remodeling play an important role in the comorbid course of COPD and respiratory tuberculosis. These mechanisms are of diagnostic interest and are promising therapeutic targets. Thus, the aim of the current review is to discuss the mechanisms of the comorbid course of chronic obstructive pulmonary disease and respiratory tuberculosis.