Exosomes are extracellular vesicles that can be secreted by various cells and widely exist in body fluids such as blood and urine. During the progression of respiratory tract diseases, exosomes derived from epithelial and immune cells can secrete substances such as RNA and proteins, disrupting the respiratory defense system and inducing or exacerbating the disease. Exosomes derived from circulating and lung tissues can be used as potential diagnostic markers for respiratory diseases, which greatly improves the diagnostic sensitivity and specificity for respiratory diseases such as tumors and infections. The treatment of respiratory diseases is also closely related to exosomes. The low immunogenicity and high compatibility of exosomes make them effective tools for delivering molecules and drugs for treatment.