The saline Aral Sea in central Asia was once the 4th largest inland lake in the world. Desiccation of the Aral Sea as a result of diversion of inflow for irrigation has resulted in significant adverse health effects among residents of surrounding areas. This study was conducted to examine respiratory symptoms and function among children who lived in "the heavily affected disaster zone" (i.e., within 200 km of the Aral Sea), by comparing them with children who lived in "the slightly affected disaster zone" (i.e., located approximately 500 km from the Aral Sea). A questionnaire-based interview was conducted among 383 students 6-15 yr of age who lived in the study area and 432 students who lived in the reference area. Pulmonary function tests were completed by 337 children in the study area and 417 children in the reference area. Prevalence of current cough and current wheezing was higher among the study group participants. Percentage of predicted forced vital capacity (FVC% predicted) was lower in the study group (median = 96.6%) than in the reference group (median = 100.5%), and prevalence of restrictive pulmonary dysfunction was higher in the study group (10.6%) than in the reference group (2.6%). Multivariate analysis indicated that FVC% predicted was lower among females and in the study area, but was not associated with socioeconomic factors.