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Occupational respiratory diseases (ORDs) constitute one of the most prevalent groups of occupational diseases (ODs) with a multitude of diagnoses (pneumoconioses, other fibroses, infectious diseases, airway diseases such as asthma and COPD, other hypersensitivities and irritations, and most importantly, cancers. In addition to acute or subacute outcomes, ORDs may result from cumulative exposures during years or decades and in cancers latency periods of up to 50 years may occur. They often have a progressive course with severely disabling or fatal outcome. Their diagnosis is highly demanding and need multiprofessional, multidisciplinary teamwork, such as occupational medicine, pulmonology, occupational hygiene, clinical physiology, and also well-established clinical facilities with advanced laboratory and imaging resources.The diagnostic process follows the generic logic of diagnosis of ODs, including early monitoring of exposures (workplace surveillance), observation of subclinical findings of groups at risk, early notification of symptoms (workers’ health surveillance), careful examination of work and exposure history (occupational hygiene and anamnesis), clinical investigation (physical, clinical studies, laboratory analyses, imaging, possible functional testing and follow-up at work and possible provocation tests, e.g. in asthma). In cases of cancers with long latencies, the health surveillance needs to be extended upon the retirement age and beyond.In good occupational health practice, the process does not end with the diagnosis. In addition to proper treatment, a thorough statement, based on acquired evidence of the diagnosed outcome is needed for legal and insurance purposes. Rehabilitation measures may be needed. The notification to the authorities and OD registries will be made. In many countries, the examination of the workplace and feedback for prevention of further cases is obligatory. Severe and fatal cases of ODs lead e.g. in Finland to police investigation.For adequate preventive measures, structural, primary, secondary and tertiary prevention are needed and the earliest possible identification of disease is emphasised.