Background: The dramatic increase in population and industrialization in Cairo has resulted in a significant deterioration in air quality. The serious impact of air pollution in Cairo was manifested since the last 8 year in the “black smoke phenomenon" which invaded its atmosphere during the months of October and November. Methods: This study evaluated the changing trends of air quality monitoring including sulphur dioxide [SO₂], nitrogen dioxide [NO₂], Particular matter less than 10 μm in aerodynamic diameter, [PM₁₀], particulate matter less than 2.5 μm [PM_2.5], meteorological parameters as wind stability and wind seed [W.S], in Cairo during the years 2002-2004 and their relation to respiratory health risks. Results: It was found that there was a significant association between air pollutants with the number of asthma admissions, [P<0.001]. NO₂ was not found to have a significant effect on asthma admissions, [P>0.05]. There was negative correlation between wind speed and asthma admissions, [P<0.001]. Mean [+SD] values of asthma admissions during autumn [black smoke episode] were significantly increased during the year 2002-2004 where compared to other seasons, [P<0.001]. Although there was a significant decrease of PM₁₀ levels during the year 2004, when compared to previous two years, [F=15.82, P=0.000], levels of SO₂ and PM_2.5 did not change significantly all over the three years. Vehicles, industrial, and burning emissions were the largest source of particulate matter pollution in Cairo. Open Burning contributes roughly 20% to more than 30% through the months of years, but during air pollution episode, more than 45% of particulate matter was due open burning. Conclusions: Fluctuations in concentrations of SO₂, PM₁₀, and PM_2.5 are strongly enunciated with patterns of attendance at emergency departments for acute asthma. Recommendations: Although Particulate Matter Concentrations have fallen since the introduction of Cairo Air Improvement Programs in 1999, ambient air levels are still beyond the recommended air quality standards and vigorous efforts must be done to decrease burning emissions in order to improve air quality in Cairo.