The epidemiology, pathology, physiology, and clinical evaluation of coal mine related respiratory diseases were reviewed. Studies have demonstrated an increased risk of lung disease among coal workers but this risk has been found to vary depending upon the rank of the coal. Excesses in mortality due to coal workers' pneumoconiosis (CWP), emphysema, influenza, asthma, tuberculosis, and stomach cancer have also been reported. The main environmental risk factors that have been identified in the development of CWP have been coal mine dust exposure and coal rank. The relationship between the presence of irregular opacities on chest radiographs to dust exposure, symptoms, and lung function was examined. Relationships have been demonstrated between indicators of lung disease other than pneumoconiosis such as respiratory symptoms and lung function and dust exposures. Studies have implicated free radical generation and oxidative damage as mechanisms involved in coal mine induced pulmonary disease. The radiographic and pathologic features, pulmonary physiology, clinical evaluation and management, and prevention of CWP were described and discussed.