The effects of long-term exposure to air pollution on respiratory symptoms and respiratory hospitalization (for asthma, bronchitis or pneumonia) were assessed in a cross-sectional study of children (ages 7–11 years, N=667) living in a moderately industrialized city in Central Slovakia. Individual health, residence and family history data obtained through the CESAR study were coupled, using Geographic Information System (GIS) technologies, with total suspended particulate (TSP) exposure estimates derived from dispersion modeling of almost all local stationary sources. These data were used to assess, at the intra-city level and child-specific level, the potential for TSP as a risk factor for respiratory disease in children. TSP, PM10, and PM2.5 monitored ambient concentrations are highly correlated in the study location. Modeled TSP concentrations resulting from local source emissions are dominated by a large wood processing facility, suggesting variation in exposures among children. The prevalence of respiratory non-asthmatic symptoms and hospitalizations was associated with increased TSP. No association between long-term exposure to TSP and asthma diagnosis or wheeze symptoms was found. Logistic regression modeling indicated a significant increase in hospital admissions for asthma, bronchitis or pneumonia associated with increasing air pollution (OR 2.16, CI, 1.01–4.60), doctor-diagnosed bronchitis (OR 1.53, CI, 1.02–2.30), and parent-reported chronic phlegm (OR 3.43, CI, 1.64–7.16), expressed as odds for a 15 μg/m3 increase in estimated TSP exposure, and these increases are not due to differences in socio-economic, health care or other identified factors.