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Excessive exposure to coal, coal mine, and silica dust continues to occur in the United States, and many countries worldwide. These dust exposures can cause a variety of pathological responses in susceptible hosts, including pulmonary fibrosis or pneumoconiosis and chronic obstructive pulmonary disease and their resultant restrictive, obstructive, or mixed pattern pulmonary function impairments. For many years, much of the discussion on the respiratory health effects of exposure to these dusts was restricted to the fibrosing pulmonary tissue reactions in response to retained dust. This includes diseases such as coal workers’ pneumoconiosis, anthracosilicosis, anthracosis, progressive massive fibrosis, silicosis, and silicotuberculosis. Excluded were other reactions of the pulmonary parenchyma and airways to the dust which are extremely important, and can result in significant impairment in sensitive individuals …