OBJECTIVE: To evaluate clinical relevance of airway hyperresponsiveness (AHR) in subjects with chronic spinal cord injury (SCI) by investigating the prevalence of asthma-like symptoms. METHOD: Two hundred twelve patients with SCI responded to the modified questionnaire of International Study of Asthma and Allergic disease in Children (ISSAC). Among them, 28 patients underwent a methacholine bronchial provocation test to measure AHR. RESULTS: The prevalence of AHR was significantly higher in subject with chronic cervical SCI compared with that in subjects with chronic thoracic or lumbar SCI (73.3% vs. 23.1%, p=0.023). In tetraplegics, the prevalence of wheezing during last 12 months, post-exercise wheezing, sleep disturbance due to nocturnal cough or wheezing, and dust-induced breathlessness were 40.0%, 37.8%, 33.3%, and 31.1% respectively, which were significantly higher than paraplegics and general population in Korea (p<0.05, p=0.001, 0.013, 0.002, 0.004 respectively). CONCLUSION: AHR in subjects with chronic cervical SCI might be a cause of symptomatic airway disturbances such as wheezing, cough, and breathlessness.