We investigated whether residents living near the World Trade Center (WTC) continued to experience respiratory problems several years after September 11, 2001 (9/11). Residents living within one mile of the WTC surveyed after 9/11 responded two and four years later to follow-up surveys that asked about lower respiratory symptoms (LRS), medical history, psychological stress, and indoor environmental characteristics. There were declines in the proportion of residents reporting LRS, new lower respiratory diagnoses, unplanned medical visits, and asthma medication use. However, the proportion of residents reporting any LRS in the affected area at follow-up remained higher than the original proportion in the control area; residents with multiple sources of potential 9/11-related exposures were at greatest risk for LRS at follow-up. Psychological stress, dust/odors, and moisture were significantly associated with LRS at follow-up. These data demonstrate that LRS continue to burden residents living in the areas affected by the WTC disaster.