Abstract: Researches indicate that chronic diseases have been becoming leading cause of mortality worldwide. The regulatory mechanism and potential clinical application of exosomes (EXs) in chronic diseases have seized the eyes of researchers. Capsulated by lipid bilayers, EXs contain several kinds of cargoes, including multiple proteins, lipids and nucleic acid, and can be secreted by various cells. EXs promote the occurrence of “cell to cell or tissue to tissue information flow”, thus playing a critical role in the incidence and evolution of a diversity of chronic diseases, such as diabetes, central nervous system (CNS) disease, chronic obstructive pulmonary disease (COPD), cardiac-cerebral vascular disease. We searched PubMed and China National Knowledge Infrastructure (CNKI) periodical full-text database retrieval system with exosomes, chronic diseases, pathogenesis, biomarkers and treatment as keywords, from January 2012 to January 2019. The including criteria are (1) the biological function of EXs; (2) the pathogenesis of EXs in chronic diseases; (3) the application of EXs as a biomarker for chronic diseases; and (4) the use of EXs as a carrier and drug target for chronic diseases. A total of 353 literatures were included in the study. As a carrier in intercellular communication, EXs cannot be ignored in the development and progression of chronic diseases. EXs can be an ideal target for the diagnosis and treatment of chronic diseases, but so far, there are still many problems to be solved in clinical detection methods and applications.