The incidence of Chronic Inflammatory Airway Diseases (CIAD) has been steadily increasing, making it a significant contributor to the global disease burden. Additionally, the risk of airway diseases in elderly women continues to rise each year, with nutritional factors playing a crucial role in the progression of CIAD. The Geriatric Nutritional Risk Index (GNRI) is a novel tool for assessing individual nutritional status. This study aims to assess the relationship between GNRI and the risk of all-cause and cardiovascular mortality in elderly women with CIAD, providing guidance for nutritional interventions to reduce mortality risk.Data from elderly female patients and relevant indicators were sourced from the National Health and Nutrition Examination Survey (NHANES) database. Nutritional status was assessed using the GNRI, and patients were divided into four groups based on their GNRI quartiles. Weighted Cox proportional hazards regression models were used to examine the relationship between GNRI and all-cause as well as cardiovascular mortality in elderly women with CIAD. Additionally, restricted cubic spline (RCS) analysis was applied to explore the association between GNRI and different mortality outcomes, and subgroup analysis was conducted to further validate the robustness of the findings.A total of 1,417 elderly female CIAD patients were included in this study. During a median follow-up of 91 months, 515 deaths from all causes and 157 deaths from cardiovascular causes occurred. Multivariable-adjusted Cox proportional hazards models indicated that compared to the lowest GNRI quartile, the other quartiles showed a general decreasing trend in both all-cause and cardiovascular mortality risk (p < 0.05). In the fully adjusted model, the highest GNRI quartile had the lowest risks of all-cause mortality (HR = 0.40, 95% CI: 0.22-0.72, p < 0.05) and cardiovascular mortality (HR = 0.29, 95% CI: 0.11-0.78, p < 0.05).The RCS analysis demonstrated a nonlinear association between GNRI and both all-cause and cardiovascular mortality (P for nonlinearity <0.001).In elderly women with CIAD, lower GNRI levels are associated with an increased mortality risk. GNRI may serve as a potential predictive tool for both all-cause and cardiovascular mortality, providing valuable insights for nutritional interventions and clinical decision-making.Copyright © 2025 Chen, Wen, Li, Bai, Zhou, He and Deng.