Objectives: This study aimed to investigate the leading prescription and over-thecounter (OTC) drugs used for patients with respiratory disease at community pharmacies in China. Methods: Using the data from the China Health Industry Intelligence System Database in 2018, which collected data from community pharmacies (n = 11,450) in 185 cities over China. The top 50 drugs (including chemical drugs and Chinese patent medicine (CPM)) used as prescription or OTC drugs were analyzed. Results: In 2018, in terms of sales, the top 50 drugs accounted for 52.81% market share of respiratory disease at community pharmacy, including 40 OTC drugs and 10 prescription drugs. Among the top 50 drugs, the market share of OTC drugs of was about 10 times that of prescription drugs. The nature and indication of the 10 leading prescription drugs were: (1) Pudilan Xiaoyan oral liquid (CPM, pharyngitis); (2) Salmeterol xinafoate and fluticasone propionate powder for inhalation (chemical drug, asthma); (3) Montelukast sodium chewable tablets (chemical drug, asthma); (4) Budesonide formoterol powder inhalation (chemical drug, asthma); (5) Xiao’er Chiqiao Qingre granules (CPM, cold); (6) Ambroxol hydrochloride and clenbuterol hydrochloride oral solution (chemical drug, bronchitis); (7) Bailing capsule (CPM, bronchitis); (8) Xiao’er Feire Kechuan granules (CPM, cold); (9) Suhuang Zhike granule (CPM, pharyngitis); (10) Montelukast sodium tablets (chemical drug, asthma). The leading 40 OTC drugs included 8 chemical drugs and 32 CPMs, which were used for cold (21 drugs), pharyngitis (10 drugs) and cough (5 drugs). Conclusions: Complex interventions are needed to improve drug therapy management of the leading prescription and OTC drugs for patients with respiratory disease at community pharmacies in China. Community pharmacists should pay special attention to the use of chemical drugs and CPM by respiratory patients at the same time.