Objectives: To determine the level of association between the reporting of respiratory symptoms by individuals living near and away from the railway used for coal transportation, and risk factors related to living conditions, health history, environmental characteristics, and air quality in the area. Material and Methods: Prospective longitudinal study with 3 cross-sectional moments over a year and a half. A structured survey was conducted, through which individuals with respiratory symptoms and associated risk factors were identified. Particular matter 2.5 (PM_2.5) and particular matter 10 (PM₁₀) concentrations were obtained from air monitoring stations available in the area. Pooled logistic models were estimated to identify factors influencing the probability of experiencing respiratory disease symptoms. Results: Over 60% of households are located near unpaved roads with heavy traffic, and dwelling conditions are not suitable for human lodging with low or no exchange of air from the outside to the inside, and critical overcrowding. The results showed a higher risk of respiratory symptoms in children with a history of asthma or malnutrition living in homes with large windows that allow air to enter and exit, and in adults with a history of asthma, hypertension, or cigarette smoking. No significant association was found between the population’s respiratory symptoms and the concentration of particulate matter (PM_2.5 and PM₁₀), which may be related to limitations in terms of the availability of air monitoring stations near the communities that were part of the study. Conclusions: There are various factors associated with the respiratory symptoms of communities located around the road used for coal transportation by train, including the history of certain diseases in the population and characteristics of the indoor and outdoor environment of households. Int J Occup Med Environ Health. 2025;38(5)