<p>Rapid industrial growth has led to rise in energy demands, particularly fuelled by coal due to its cost-effectiveness and availability. However, coal mining is a significant source of air pollution, releasing harmful particulate matter that adversely affects human health. This study quantifies the prevalence, severity, and types of pulmonary impairment among residents living near high-sulfur coal mines in Northeast India and assesses the impact of coal mining, composition of particulate matter, and coal combustion in coke oven plants on lung function. Spirometry tests were conducted on the volunteer residents (<i>N</i> = 229, age 7–65 years, residing &gt; 3 years) and 104 controls with similar characteristics. Using a questionnaire and spirometry, pulmonary impairment was estimated following the guidelines of the Indian Chest Society, 2019. Pulmonary impairment was found to be 34.93% in exposed individuals, compared to 18.26% in controls. Obstructive impairment was the most common lung disorder (17.90% vs. 10.57%), followed by mixed (9.17% vs. 3.84%) and restrictive (7.86% vs. 3.84%) in exposed and unexposed, respectively. The multiple regression analysis showed significant negative associations between exposure and FEV₁% (-9.519, 95% CI: -12.759, -6.279) and between exposure and FVC % (-9.952, 95% CI: -12.318, -7.586). Similarly, the logistic regression analysis revealed that the exposed individuals have 2.83 times more pulmonary impairment (OR: 2.83, 95% CI: 1.540–5.207). Exposed populations showed lower mean FEV₁ and FVC values and higher lung impairment compared to controls, with obstructive impairment being the most prevalent. Lung capacities were negatively associated with exposure and smoking. </p>