Respiratory symptom questionnaires (RSQ) are useful in assessing the health of workers exposed to respiratory hazards. To facilitate interpretation of RSQ, we studied RSQ responses and results of objective tests among 199 underground coal miners and 212 non-miner blue collar workers. Spirometry, methacholine challenge, a self-administered standardized RSQ, and complete smoking, medical, and work histories were recorded initially and after 5 years of follow-up. For each symptom item, individuals who responded Yes were compared to those who said No at the same survey, assessing differences in percent predicted forced expired volume in one second (ppFEV1) and proportion of methacholine responders (%HR), using t-test and Chi-square statistics, respectively. Significant associations included: 1) chronic cough, chronic phlegm, ever wheezing, or history of asthma with both lower ppFEV1 and greater %HR; 2) dyspnea on level ground (SOB) with reduced ppFEV1; and 3) attacks of dyspnea with wheezing (SOBWZ), a history of asthma, or a history of hay fever with greater %HR. Multiple logistic regression analysis for repeated measurements of symptom prevalence was also done using generalized estimating equations, controlling for age, smoking, and coal mining status. Individuals with cough, phlegm, SOB, or ever wheeze had significantly lower ppFEV1; those with SOBWZ, history of asthma, history of hay fever, or persistent wheeze had a greater %HR. Positive methacholine challenges were 3 and 5 times more likely in participants reporting SOBWZ or ever asthma. Results of this study can facilitate the interpretation of individual responses to RSQ.