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Cadmium is frequently used in manual jewelry industries. Although its toxicity on lung function is well-known, the mechanism is not well-understood.Among 26 goldsmiths exposed to cadmium (mean age 35.9 ± 5.0 years) and 17 referent workers without direct exposure (36.6 ± 6.6 years), we measured blood and urinary cadmium concentration and performed spirometry and quantified leukocytes and comet formation in the cells from spontaneously expectorated sputum samples.The goldsmiths had higher cadmium concentration in urine (mean 6.14 ± 1.63 vs. 0.47 ± 0.17 μg/dl) and blood (0.90 ± 0.23 vs. 0.02 ± 0.007 μg/dl) than the referents, which were inversely associated with FEV1/FVC. Cadmium exposure also resulted in higher neutrophils (%) and lower macrophage (%) prevalence in the sputum and also caused substantial DNA damage in the lung cells among the goldsmiths than the referents (69 vs. 14%).Altered lung function among cadmium-exposed goldsmiths was associated with enhanced inflammatory response and increased cellular DNA damage in the lungs. Am. J. Ind. Med. 58:617–624, 2015. © 2015 Wiley Periodicals, Inc.