The results of a biomonitoring survey carried out in the town of Pistoia (central Italy) using the biodiversity of epiphytic lichens and the accumulation of heavy metals in thalli of Parmelia caperata as indicators of air pollution are reported. Compared to previous surveys, the overall situation generally improved, with higher lichen diversity at most stations and lower metal concentrations in P. caperata thalli. However, the general picture according to a calibrated sale of environmental naturality/alteration was substantially negative, with about 87% of the study area classified as 'altered' (including the lichen desert) or 'semi-altered'. To explain this apparent contradiction, it has been suggested that lichen colonization is determined by declining SO2 concentrations, while major injuries to lichen communities are caused by the constantly high levels of NOX. In spite of the low levels of Pb measured in P. caperata thalli, vehicular traffic was excluded as the main source of atmospheric pollution. Domestic heating seems to be the main case of changes in the diversity of epiphytic lichens in the study area.