The interaction between epithelial cells and macrophages plays a crucial role in the progression of lung diseases, including immune defense, inflammation regulation, tissue repair, and regeneration. However, an imbalance in this interaction can contribute to the development of various lung diseases. In idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and lung cancer, macrophages can promote disease progression by secreting cytokines that act on epithelial cells. Simultaneously, activated epithelial cells release cytokines to recruit and activate more macrophages in a positive feedback loop. Thus, comprehensive studies of the interactions between epithelial cells and macrophages in various lung diseases have the potential to identify new therapeutic targets and develop innovative strategies for disease management. This review aims to summarize the current knowledge regarding the interaction between epithelial cells and macrophages in idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and lung cancer, with the goal of inspiring new research directions for the treatment of lung diseases.