Disparities in outcomes for pulmonary diseases are the most evident of all chronic diseases. Because of disproportional poverty and urban living, African Americans have an increased exposure to indoor and outdoor pollution, occupational and environmental hazards, and tobacco smoke, which contribute to disparities in prevalence and outcomes of chronic obstructive pulmonary disease (COPD). African American patients had a higher rate of asthma-COPD overlap with asthma as a predominant cause for resistant treatment and hospital readmission. African Americans also have a higher rate of chronic bronchitis and a lower rate of emphysema when compared to European Americans. African Americans with COPD are significantly younger, smoke less, report concurrent asthma more frequently, and have less radiographic emphysema on volumetric computed tomography. Sarcoidosis occurs much more frequently in African Americans and is associated with a much higher mortality. Finally, the nuanced differences inherent to obstructive sleep apnea, interrupted sleep, and daytime sleepiness in African Americans is reviewed.