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Even in countries with a well-developed occupational health legislation and infrastructure, self-employed workers generally fall outside the scope of the legislation and services that are intended to prevent accidents and disease at work. In curative medicine, little attention is paid to possible occupational causes of medical conditions.Yet, self-employed people also run occupational health risks in agriculture, crafts, or service professions. The burden of occupational disease among self-employed workers is not known.A retrospective study was conducted on records of all currently self-employed workers who were referred tot the outpatient clinic dedicated to occupational and environmental health within the division of pneumology of the University Hospitals of Leuven during the period 2000–2014. Their main demographic, occupational and medical characteristics were compared to those of salaried employees seen during the same period.150 self-employed workers were identified. They represent 5% of all consultations during this period. 80% were men. 91% had active working age. 70% worked as self-employed throughout their careers, 30% had also worked as salaried worker in the past. The main sectors were construction (31%), food (12%), agriculture (11%) and beauty care (11%). 73% had respiratory disease with asthma as the most common diagnosis (n=49). The suspected causative agents were synthetic chemicals (n=52), biological agents (n=42) and mineral substances (n=33). Subpopulations of bakers, painters and hairdressers had non-significant different characteristics compared to their salaried colleagues, except for age in hairdressers.Self-employed workers may suffer from occupational respiratory and non-respiratory diseases. Although the evidence is largely anecdotal, it appears that the severity at clinical presentation is higher in self-employed persons than in salaried employees. Although the socio-economic consequences of occupational disease are often dramatic for most workers, it appears that this is even more the case for self-employed persons.