Sandstorms represent a major natural hazard in the Arabian Peninsula. Their pulmonary consequences can be life-threatening, especially to those with a history of allergies, asthma, and chronic obstructive pulmonary diseases. Novel presentations of respiratory diseases caused by sandstorms can now be traced to specific chemical and organic components of sandstorms. We present an update of the pathophysiology of pulmonary conditions based on the results of clinical and epidemiologic research as well as from greater knowledge of the complex chemical composition of sandstorms. This has led to more precise therapeutic approaches to severe respiratory illnesses and a greater understanding of risk factors for morbidity and mortality due to Arabian sandstorms.