Objective: The purpose of this study was to assess the lung epithelial atypical changes (if any), which might be associated with continuous exposure to air pollution resulting from motor vehicles maintenance. Methodology: This is a case control study, investigated 250 participants by cytological methods. Of the 250 participants, 200 were cases exposed to vehicle maintenance emissions air pollution and 50 were controls (non-exposed). Early morning expectorated sputum specimen was obtained and cytologically assessed. Results: Cytological atypia was identified in 7 (3.5%) out of the 200 cases and could not be identified in 193 (96.5%) cases, whereas, in the control group, cytological atypia was not found. The risk of cytological atypia, which is associated with exposure to vehicle maintenance emissions air pollution, the 95% confidence interval (95% CI) and relative risk (RR); RR=3.9 (0.2199 to 69.7010), P=0.3529. Metaplasia was identified among 26 (13%) cases and 2/50 (4%) in the controls. The risk of metaplasia that is associated with exposure to vehicle maintenance emissions air pollution, the 95% CI and RR=3.5 (0.8218 to 15.649), P=0.0893. Conclusion: The exposure to vehicle maintenance air pollution increases the risk of lung epithelial atypical changes, which may develop in to precancerous and cancerous changes.