Aims: This systematic review and meta‐analysis aimed to evaluate the effects of home‐based telehealth compared with usual care on six‐minute walking distance (6MWD), health‐related quality of life, anxiety and depression in patients with chronic obstructive pulmonary disease. Methods: We identified randomized controlled trials through a systematic multidatabase search. Titles and abstracts were assessed for relevance. Two authors independently extracted data and assessed the risk of bias and quality of evidence. Meta‐analyses were conducted using Review Manager and Stata. Results: We included 32 randomized controlled trials (n = 5232). Devices used for home‐based telehealth interventions included telephones, videos, and combined devices. The quality of the evidence was downgraded due to high risk of bias, imprecision, and inconsistency. Home‐based telehealth significantly increased 6MWD by 35 m (SD = 30.42) and reduced symptom burden by 3 points (SD = −2.30) on the COPD assessment test compared with usual care. However, no significant differences in anxiety and depression were noted between the home‐based telehealth group and the standard care group. In subgroup analysis, home‐based telehealth significantly improved 6MWD and health status after 6–12 months and >12 months. Conclusion: Low quality evidence showed that home‐based telehealth interventions reduce symptom burden and increase walking distance to a clinically meaningful extent in patients with COPD. However, no effects on depression and anxiety were observed. Summary statement: What is already known about the topic? In the context of chronic obstructive pulmonary disease progression, exacerbation of symptoms results in negative impacts on physical condition and psychological status.The overall effect of telehealth for patients living with chronic obstructive pulmonary disease is unclear based on different results reported in existing studies. What this paper adds? Home‐based telehealth improved the six‐minute walking distance and health status in patients with chronic obstructive pulmonary disease, but it did not improve anxiety and depression.Home‐based telehealth based on combined devices but not telephone or video improved the six‐minute walking distance and health status.Home‐based telehealth significantly improved six‐minute walking distance and health status in the 6–12 months subgroup and the more than 12 months subgroup but not at <6 months. The implications of this paper: Telehealth offers a feasible method to provide long‐term and regular health care to patients with chronic obstructive pulmonary disease living at home.Telehealth can help expand the recognition, accessibility and application of medical care services for patients with chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]