The literature is reviewed on patients developing respiratory symptoms while receiving D-Penicillamine, most of whom suffered from rheumatoid arthritis. The manifestations were (in decreasing frequency) bronchiolitis obliterans, interstitial pneumonitis, a Good pasture's like syndrome and bronchospasm. For each complication we discuss diagnostic criteria, the implication of the drug and the pathogenesis. In addition we make suggestions regarding patients on D-Penicillamine and emphasize the need for accurate reporting of adverse pulmonary effects to enlarge the epidemiological picture.