Although for forty years already broncho-pulmonary pathology has been described in workers exposed to hard-metal (i.e. alloys of tungsten carbide and cobalt) and although cobalt is considered the offending agent of this hazard, these abnormalities have almost not been found after exposure to cobalt alone except in animal experiments. Recently we detected clearcut broncho-pulmonary pathology in 48 diamond polishers (i.e. nearly 1% of those exposed) attributable to the ultrafine cobalt dust from the cutting surface of polishing disks, in which it was used as a cementing matrix for microdiamonds without any tungsten carbide. Nineteen of these patients presented with a fibrosing alveolitis documented in 6 by lung biopsy and in 12 by broncho-alveolar lavage, both of which revealed characteristic multinucleated giant cells. Thirteen suffered from asthma of occupational origin, in 9 proven by cobalt-inhalation tests, and in 5 by peak flow measurements at the workplace. Sixteen had mixed bronchial and alveolar pathology or were incompletely documented. A cross-sectional study in about 200 diamond polishers showed a significant correlation between exposure to cobalt and decrease in lung function. The strikingly harmful effects of cobalt can be explained by the chronic exposure to very small particles with markedly increased solubility. The pathogenesis of the broncho-pulmonary pathology may be attributed to the cytotoxic as well as to the sensitising (i.e. allergic and/or idiosyncratic) actions of cobalt.