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Procalcitonin (PCT)-guided therapy may optimize antibiotic use in respiratory infections and chronic lung diseases. This systematic review aimed to assess the role of PCT-guided protocols in reducing antibiotic duration, length of hospital and ICU stay, and clinical outcomes in patients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and chronic obstructive pulmonary disease (COPD). A secondary literature search was conducted using the databases PubMed and Google Scholar to identify the relevant studies published between January 2003 and December 2023. Eligible studies included peer-reviewed original research (clinical trials, observational, cohort, and case-control studies) evaluating PCT in CAP, VAP, HAP, or COPD, including viral and/or bacterial lower respiratory tract infections (LRTIs) in humans. The excluded studies were animal studies, studies not involving LRTIs, PCT studies lacking extractable data, and non-peer-reviewed editorials, opinions, and conference abstracts. Inconsistency across studies was assessed by heterogeneity analyses and publication bias using funnel plots. Twenty-four studies involving 16,134 patients were included. Across all conditions, PCT-guided therapy reduced antibiotic duration, particularly in CAP, without increasing mortality. Studies included in the CAP group reported that patients in the PCT group benefited from a shorter duration of therapy, with the treatment period decreasing from an average of 13.3±6.5 days in the control group to 11.7±6.2 days in the PCT group. Similarly, the PCT group had significantly reduced ICU stays. For COPD, hospital stay was significantly reduced, though fewer studies demonstrated ICU benefits. PCT-guided protocols may effectively help in better treatment strategies for CAP and COPD management.