To investigate the risk factors for pneumoconiosis associated with asthma. A total of 256 pneumoconiosis patients diagnosed by chest X-ray at our hospital were analyzed. Based on pulmonary function tests, pneumoconiosis cases were divided into non-asthma and asthma-complicated groups. Clinical characteristics, clinical manifestations, and laboratory indicators of both groups were collected and compared. Risk factors for asthma in pneumoconiosis patients were identified using univariate and multivariate logistic regression analyses. Among the 256 pneumoconiosis patients, 79 had asthma. The age, BMI, incidence of pneumoconiosis categories II and III, exposure time, IgE levels, FeNO levels, and the incidence of wheezing and dyspnea were all higher in the asthma group compared to the non-asthma group. Conversely, FEV1, FEV1%predicted, FEV1/FVC, and the incidence of cough and expectoration were lower in the asthma group. Multivariate logistic regression analysis revealed that exposure time, low level of FEV1 and FEV1/FVC, high IgE levels, elevated FeNO, and wheezing were independent risk factors for asthma in pneumoconiosis patients. In this study, the prevalence of pneumoconiosis complicated with asthma was 30.9%. High exposure time, elevated IgE levels, increased FeNO levels, incidence of wheezing, low level of FEV1, and FEV1/FVC suggest that pneumoconiosis patients are significantly at increased risk of asthma.