Purpose <p>Exposure to paper dust in the workplace might increase the risk of reduced lung function. This study aims to evaluate the relationship between paper dust exposure and lung function among workers in the paper industry in Ethiopia.</p> Methods <p>A comparative cross-sectional study assessed lung function in workers exposed to dust in the paper industry and compared them with controls from the water bottling industry. Lung function tests were conducted using a portable spirometer. A job exposure matrix was developed to estimate cumulative exposure to inhalable paper dust. Analysis of covariance was performed to compare mean lung function between exposed and control groups and multivariate linear regression analysis was carried out for workers exposed to paper dust.</p> Results <p>There was a significant difference in forced expiratory volume in one second (FEV₁) between the groups. FEV₁ was 2.62&#xa0;l in the exposed group, compared to 2.97&#xa0;l in the control group. The multiple linear regression analysis revealed that cumulative paper dust exposure was associated with a reduction in both FEV₁ and forced vital capacity (FVC). Each unit increases in dust exposure (measured in mg year/m²) was associated with a 0.010&#xa0;l decrease in both FEV₁ and FVC in females and a 0.005-liter decrease in males.</p> Conclusions <p>The findings indicate a significant exposure-response relationship between cumulative paper dust exposure and a decline in lung function with the effect being more pronounced among female workers than among males. Based on these results, we recommend the paper industry to implement effective dust control strategies.</p>