Coal mine and silica dust cause significant respiratory disease in spite of modern dust control regulations. Susceptible individuals in exposed populations may develop fibrosing lung disease, obstructive airways disease, including chronic bronchitis and emphysema, or lung cancer. A careful occupational history that elicits exposure to respiratory hazards is the cornerstone of an accurate diagnosis. Treatment involves removal from exposure, supportive care, pulmonary rehabilitation, and when disabling disease is present, assistance obtaining compensation.