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The authors investigated the effect of charcoal smoke exposure on risks of acute upper and lower respiratory infection (AURI and ALRI) among children under age 18 months in Santo Domingo, Dominican Republic (1991-1992). Children living in households using charcoal for cooking (exposed, n = 201) were age-matched to children living in households using propane gas (nonexposed, n = 214) and were followed for 1 year or until 2 years of age. Fuel use and new episodes of AURI and ALRI were ascertained biweekly through interviews and medical examinations. Household indoor-air concentration of respirable particulate matter (RPM) was measured in a sample of follow-up visits. Incidences of AURI and ALRI were 4.4 and 1.4 episodes/child-year, respectively. After adjustment for other risk factors, exposed children had no significant increase in risk of AURI but were 1.56 times (95% confidence interval: 1.23, 1.97) more likely to develop ALRI. RPM concentrations were higher in charcoal-using households (27.9 microg/m(3) vs. 17.6 microg/m(3)), and ALRI risk increased with RPM exposure (10-microg/m(3) increment: odds ratio = 1.17, 95% confidence interval: 1.02, 1.34). Exposure to charcoal smoke increases the risk of ALRI in young children, an effect that is probably mediated by RPM. Reducing charcoal smoke exposure may lower the burden of ALRI among children in this population. [ABSTRACT FROM AUTHOR]