Diesel exhaust is a complex mixture of gaseous and particulate compounds resulting from an incomplete combustion of diesel fuel. Controlled human exposures to diesel exhaust and diesel exhaust particles (DEP) have contributed to understanding health effects. Such acute exposure studies of healthy subjects to diesel exhaust and DEP demonstrate a pro-inflammatory effect in the lung and systemically but only at higher concentrations (with a threshold dose approximating 300 µg/m3). Unexpectedly, there appears to be a lack of an inflammatory response to diesel exhaust and DEP in asthmatic individuals. Controlled human exposure studies of cardiovascular effects show that, comparable to other particle-associated exposures, diesel exhaust has a capacity to precipitate coronary artery disease. In addition, there is a relationship between diesel exhaust and DEP exposure and vascular endpoints; these effects in diesel exhaust may be diminished with removal of DEP. Many extra-pulmonary health effects of diesel exhaust exposure, including systemic inflammation, pro-thrombotic changes, and cardiovascular disease, are considered consequent to pro-inflammatory events and inflammation in the lung. Future research will focus on the relative importance of diesel exhaust components, potential interactions between components and other pollutants, effects in sensitive individuals, and effects of longer or repeated exposures.