The profile of both infectious and non-infectious lung diseases in South Africa over the past century reflects prevailing sociopolitical and economic forces. The lung, perhaps more than any other organ system is influenced by poverty, occupation and personal habits. These influences are seen in the association between tuberculosis and pneumoconiosis first described in miners, the increasing prevalence of asthma and smoking-related chronic obstructive pulmonary disease, and the current dual epidemics of tuberculosis and infections associated with the human immunodeficiency virus (HIV). The global prediction for developing countries is that by the year 2020 respiratory diseases (including infections) will account for a large majority of deaths and a considerable burden of disability adjusted life years. The country-wide Demographic and Health Surveys of 1998 and 2003 have provided data on symptom prevalence in South Africa. The Lung Health Survey 2002 performed in Cape Town provides disease prevalence and has identified complex interactions between causative factors and disease. Consistent and biologically plausible associations between smoking and susceptibility to tuberculosis and pneumonia in HIV-infected patients have been reported. These findings are relevant both to the planners of public health interventions, and to researchers exploring disease mechanisms and potential remedies.