A cross-sectional study was conducted in a randomly selected factory producing Portland cement in eastern Saudi Arabia to determine the prevalence of respiratory symptoms and diseases and chest x-ray changes consistent with pneumoconiosis in the employees. A sample of 150 exposed and 355 unexposed employees was selected. A questionnaire about respiratory symptoms was completed during an interview. Chest x-rays were read according to the ILO criteria for pneumoconiosis. Dust level was determined by the gravimetric method. Concentrations of personal respirable dust ranged from 2.13 mg/m3 in the kilns to 59.52 mg/m3 in the quarry area. Cough and phlegm were found to be related to cigarette smoking, while wheezing, shortness of breath, and bronchial asthma were related to dust levels. It is recommended that engineering measures be adopted to reduce the dust level in this company, together with health monitoring of exposed employees.