In the industry, the potential for exposure to cobalt metal dust is particularly important during the production of cobalt powder and the processing and use of hard metals and other cobalt-containing alloys. The different adverse health effects reported in these workers are reviewed. One of the main target organs is the respiratory tract, and this article concentrates on the lung parenchymal reactions induced by cobalt-containing dust. Clinical and epidemiological data indicate that this manifestation is rarely, if ever, induced by pure cobalt metal dust alone, but requires the concomitant inhalation of other compounds such as tungsten carbide in the hard metal industry (hard metal disease). Experimental studies demonstrate that cobalt metal and metallic carbides interact to produce an elective lung toxicity. Recent work on the mechanism of this interaction, which is based on the production of activated oxygen species, is reviewed. A practical implication in industrial hygiene should be that permissible exposure levels to Co dust might have to be different when exposure is to pure Co particles or an association with carbides.