Air pollution is a major environmental and public health challenge, particularly in urban areas of developing countries where pollutant levels frequently exceed international safety standards. This study aimed to evaluate the association between air pollution exposure, respiratory symptoms, and quality of life among adults residing in urban areas of Al-Diwaniyah City, Iraq. A cross-sectional study was conducted in 24 primary healthcare centers from January to March 2026. A total of 400 adults were recruited using a convenience sampling technique. Data were collected using the Air Quality Perception (AQP) scale, the European Community Respiratory Health Survey (ECRHS), and the WHOQOL-BREF questionnaire. The results showed that 81.0% of participants had a moderate perception of air pollution exposure, while 39.0% reported chronic respiratory diseases. More than half of the participants (57.3%) had poor quality of life. Air pollution perception was significantly associated with respiratory health indicators and negatively correlated with the physical, psychological, social, and environmental domains of quality of life (p < 0.001). The findings indicate that air pollution exposure has a substantial adverse effect on respiratory health and quality of life among adults living in urban areas.