In this review, we describe the burden of respiratory illness in Australian indigenous communities and examine evidence of aetiology. We have reviewed the results from studies of respiratory infections and asthma-like symptoms conducted in remote and non-remote indigenous communities and contrasted them with data from comparable studies in non-indigenous communities. Although bias cannot be controlled and generalizability is an issue, the data are the only information available and, as such, provide a basis for a hypothesis generating approach to better health care. The evidence suggests that many indigenous people, especially those who live in non-remote regions, have asthma-like symptoms that are largely of an infectious rather than an allergic origin. Moreover, indigenous communities continue to be exposed to low immunisation rates, to have low rates of breastfeeding and to have high rates of cigarette smoking, all of which have the potential to increase the prevalence of respiratory illnesses. It is important to identify the most effective treatments and preventive strategies for respiratory symptoms that are prevalent in indigenous children. Respiratory symptoms that are largely of a bacterial-infectious origin may not benefit from commonly prescribed asthma therapies and, without appropriate treatment, may lead to ongoing health problems.