A cross-sectional assessment of indoor air quality in Nepal and its health effects revealed that solid biomass fuels (animal dung, crop residue, and wood) were the main sources of indoor air pollution affecting health. The average smoke level (PM10) in kitchens using biomass fuels was about three times higher than that in those using cleaner fuels (kerosene, LPG, and biogas). Respondents in 98 randomly selected households included 168 who cooked daily meals, of whom 94% were disadvantaged women. Biomass smoke caused significantly more respiratory disorders than did cleaner fuels. Categorized data analysis demonstrated significant associations between biomass smoke pollution and respiratory symptoms such as cough; phlegm; breathlessness; wheezing; and chronic respiratory diseases such as COPD and asthma. The prevalences of respiratory illnesses and symptoms were considerably higher in those living in mud and brick houses compared with concrete houses. Prevalences were also higher in those living on hills and in rural areas compared with flatland and urban areas.