Abstract: Chronic obstructive pulmonary disease (COPD) is an important respiratory disease that endangers human health, characterized by degenerative changes, inflammation and fibrosis of lung structure. Compared with taking medicine, acupuncture can improve dyspnea, exercise endurance and immunity of patients with less side effects, but its mechanism is not clear. Inflammatory mechanisms play an important role in the development of COPD, in which macrophages are important inflammatory participants. Macrophages are highly plastic and can polarize into M1-type macrophages and M2-type macrophages when stimulated by the microenvironment. After activation, M1 macrophages can release pro-inflammatory cytokines and have pro-inflammatory effects. M2 macrophages have anti-inflammatory and immunomodulatory functions. Macrophage polarization plays a key role in the pathogenesis of COPD. Exosomes are nanoscale double-membrane vesicles that can be secreted by a variety of cells, which can mediate intercellular or interorgan communication, regulate cell function or cell activity. Exosomes have been reported to be involved in macrophage polarization and have a role in regulating inflammation. As an important breakthrough, exosomes have attracted more and more attention in mechanism study of the development of COPD. Therefore, from the point of view of exosomes participating in macrophage polarization, our study explain the pathogenesis of COPD and analyzes the feasibility of acupuncture in the treatment of COPD by regulating exosomes which participants in macrophage polarization.