In this review, we have synthesised evidence that six exosomal miRNAs, including miR-107, miR-125a-5p, miR-7219-3p, miR-23a-3p, miR-552-3p, and let-7i-5p, critically regulate silicosis-related lung fibrosis by modulating key profibrotic and inflammatory pathways (TGF-β, NF-κB, MAPK, NLRP3). The gene discussed is TGFB1; the disease is silicosis.