Study objectives: Inhalation of harmful substances is common in the workplace. The purpose of this study was to describe the epidemiology of fatal occupational inhalations in the United States. Design: Data from the Census of Fatal Occupational Injuries from 1992 to 1998 were analyzed. Information on demographic characteristics, occupation, and industry was used to calculate specific mortality rates, and the inhaled substances were identified. Results: Nationwide, there were 523 cases of fatal occupational inhalation, with a mortality rate of 0.56 deaths per 1, 000, 000 worker-years. The rate of death was greater for men (1.01/1, 000, 000) than for women (0.03/1, 000, 000), and workers ≥ 65 years of age had the highest mortality. Mining was the industry with the highest mortality rate (6.64/1, 000, 000). The occupations with the highest rate were firefighters (3.54/1, 000, 000) and farming, forestry, and fishing occupations (2.84/1, 000, 000). Nearly half of the inhalation victims were constructing, repairing, cleaning, inspecting, or painting when the injury occurred. Overall, carbon monoxide was the most frequently inhaled substance (33.5%). The incidence of fatal carbon monoxide inhalations was twice as high in the winter as in the summer. The proportion of workers killed by carbon monoxide poisoning increased with increasing age. Conclusions: Work-related inhalations cause more deaths than any other mode of exposure to harmful substances. Recognizing those circumstances that pose a higher risk for maintenance and repair workers, as well as upgrading carbon monoxide poisoning prevention programs, could have a major impact in reducing fatal work-related inhalation injuries.