Microbial air quality (MAQ) is unambiguously linked with one's health particularly in pulmonology. Children remain more vulnerable in acquiring airborne infections than adults. MAQ studies and management are being implemented in developed countries, yet such information and actions are scarce in developing countries. Herein, we aimed to determine the indoor and outdoor airborne microbial concentrations in a rural versus urban perspective and their association with paediatric respiratory health. Preschools, one representing an urbanized and the other, a rural area, from Kandy, Sri Lanka, were considered. Respiratory health of 146 children (age; 3-6 years) was examined, and questionnaire-based information was obtained from their parents. Air samples were taken using natural sedimentation, single-stage viable sampler and fine particulate sampler to calculate the total microbial and culturable counts. Inhalation dose rates were calculated as per standard reference values. Microorganisms were identified using 16SrRNA sequencing. Accordingly, 57.97% (n = 40) urban and 31.17% (n = 24) rural subjects suffered from at least one respiratory disease, upper respiratory tract infections, rhinitis, wheeze, etc. High total microbial counts (cells/m 3) were seen in urban preschool (indoor: 4.66 × 10 5 vs. 2.45 × 10 5 , outdoor: 4.29 × 10 4 vs. 2.74 × 10 4). Inhalation dose rates were high in urban preschool, both indoor and outdoor (2.00 × 10 4 and 1.05 × 10 4 cells/kg day). Irrespective of the site, indoor microbial counts were high and majority were opportunistic pathogens: Pseudomonas stutzeri, P. fluorescens, P. putida, Brevundimonas diminuta, Enterobacter cloacae, Bacillus pumilus, Acinetobacter calcoaceticus, B. cereus, Pseudoescherichia vulneris and Morganella morganii. Accordingly, observed dynamics can be a risk factor for the higher respiratory disease prevalence seen among urban preschoolers.