Abstract
Urban respiratory issues are increasingly important because urban populations are exposed to air pollution, dense built environments, climate-related stressors, and unequal environmental conditions. This systematic literature review aimed to identify the determinants most frequently associated with urban respiratory problems, categorize the reported respiratory impacts, and synthesize how risk factors, protective factors, population vulnerability, and biological mechanisms are connected. The review followed the PRISMA framework and used literature identified through Scopus and PubMed-related searches and validated sources. Peer-reviewed studies published in English or Indonesian from 2020 to 2026 were considered. Fifty-three studies were included in the main synthesis, with additional studies used as supporting sources. Narrative synthesis, thematic analysis, and quality appraisal using Joanna Briggs Institute tools adapted to study design were applied. The evidence consistently identified particulate matter, particularly PM2.5 and PM10, traffic-related emissions, household air pollution, industrial exposure, poor ventilation, built-environment density, temperature extremes, and residential environmental quality as major determinants. Reported outcomes ranged from respiratory symptoms and impaired lung function to asthma, COPD, respiratory infections, hospitalization, emergency visits, respiratory mortality, and lung cancer. Green space, urban ventilation, and microclimate may modify risk, but their effects depend on spatial, ecological, pollution, and population contexts. The resulting framework integrates proximal and distal determinants, protective factors, vulnerability, biological mechanisms, and respiratory outcomes.