Inhalation accidents are the fifth most common cause of illness reported by occupational and chest physicians to the SWORD surveillance scheme, with an estimated total of 1180 cases in the 5-year period 1989-1994. Questionnaires were sent to all physicians still participating, to record the circumstances of each inhalation accident they had reported between January 1990 and July 1993, covering case management and any resultant effects on health or employment; 93% of physicians returned the forms completed with adequate data on 85% of cases. From the information provided, 30% of the accidents resulted from lack of effective respiratory protection or other contraventions of safety regulations, 19% from leaks or spills and 13% from equipment failure. Resultant symptoms were described in 92% of cases: of these 48% were respiratory, 12% non-respiratory or toxic and 39% a combination of the two. The symptoms persisted often with absence from work for 1 month or more, in 26% of cases, including 9% with asthma or reactive airways dysfunction syndrome (RADS), 11% other respiratory diseases, 3% non-respiratory conditions and 3% unspecified. It was evident that cases reported by chest physicians were more seriously ill than those from occupational physicians, but of those with persistent symptoms the proportion with asthma or RADS was fairly similar in the two groups (24 and 37%, respectively). Agents associated with asthma or RADS were mainly respiratory irritants and those associated with non-respiratory conditions were organic chemicals or combustion products. Published by Elsevier Science Ltd.