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Abstract Objective In a population with prior exposure to the World Trade Center (WTC) disaster, this study sought to determine the relationship between Hurricane Sandy-related inhalation exposures and post-Sandy lower respiratory symptoms (LRS). Methods Participants included 3835 WTC Health Registry enrollees who completed Wave 3 (2011-2012) and Hurricane Sandy (2013) surveys. The Sandy-related inhalational exposures examined were: (1) reconstruction exposure; (2) mold or damp environment exposure; and (3) other respiratory irritants exposure. LRS were defined as wheezing, persistent cough, or shortness of breath reported on ≥1 of the 30 days preceding survey completion. Associations between LRS and Sandy exposures, controlling for socio-demographic factors, post-traumatic stress disorder, and previously reported LRS and asthma were examined using multiple logistic regression. Results Over one-third of participants (34.4%) reported post-Sandy LRS. Each of the individual exposures was also independently associated with post-Sandy LRS, each having approximately twice the odds of having post-Sandy LRS. We found a dose-response relationship between the number of types of Sandy-related exposures reported and post-Sandy LRS. Conclusions This study provides evidence that post-hurricane clean-up and reconstruction exposures can increase the risk for LRS. Public health interventions should emphasize the importance of safe remediation practices and recommend use of personal protective equipment. ( Disaster Med Public Health Preparedness . 2018;12:697-702)