Background: Mount Oyama, on the Japanese island of Miyakejima, began erupting in June 2000, necessitating the evacuation of 3,000 island residents. Volcanic gas emissions, primarily consisting of sulfur dioxide (SO2), gradually decreased and residents returned to the island after the evacuation order was lifted in February 2005. Objectives: To assess the exposure-effect and exposure-response relationships between SO2 exposure and effects on respiratory system in adult Miyakejima residents. Method: Health checkups focusing on pulmonary function and respiratory/irritative symptoms were conducted six times every November from 2006 to 2011. The study population comprised 168 subjects who underwent all health checkups. SO2 concentrations were measured at six fixed monitoring stations in inhabitable areas. Result: Based on the annual mean SO2 concentration, inhabitable areas were classified into three categories; namely, lower (L), higher (H-1), and highest (H-2) areas. Average SO2 concentrations (ppb) during 3 months prior to each health checkup dropped from 11.3 to 3.29, 32.2 to 13.4 and 75.1 to 12.6 from 2006 to 2010/2011 in L, H-1, and H-2. No significant declines in pulmonary function were observed in all areas. However, prevalence of subjective symptoms such as "Cough," "Irritation and/or pain in throat," "Irritation, runny nose, and/or nasal sniffles," and "Irritation and/or pain in the eyes," dependently increased on SO2 concentration. Odds ratios were statistically significant at approximately 70 ppb of SO2 or above. Conclusion: Adult residents of Miyakejima island showed no deterioration in pulmonary function at SO2 levels, but complained of respiratory/irritative symptoms in an SO2 concentration-dependent manner.