Recent epidemiological studies have shown an association between increased particulate urban air pollution and adverse health effects on susceptible parts of the population, in particular the elderly with pre-existing respiratory and cardiovascular diseases. Urban particles consist of three modes: ultrafine particles, accumulation mode particles (which together form the fine particle mode) and coarse mode particles. Ultrafine particles (those of < 0.1 micron diameter) contribute very little to the overall mass, but are very high in number, which in episodic events can reach several hundred thousand/cm3 in the urban air. The hypothesis that ultrafine particles are causally involved in adverse responses seen in sensitive humans is based on several studies summarized in this brief review. Studies on rodents demonstrate that ultrafine particles administered to the lung cause a greater inflammatory response than do larger particles, per given mass. Surface properties (surface chemistry) appear to play an important role in ultrafine particle toxicity. Contributing to the effects of ultrafine particles is their very high size-specific deposition when inhaled as singlet ultrafine particles rather than as aggregated particles. It appears also that ultrafine particles, after deposition in the lung, largely escape alveolar macrophage surveillance and gain access to the pulmonary interstitium. Inhaled low doses of carbonaceous ultrafine particles can cause mild pulmonary inflammation in rodents after exposure for 6 h. Old age and a compromised/sensitized respiratory tract in rodents can increase their susceptibility to the inflammatory effects of ultrafine particles significantly, and it appears that the aged organism is at a higher risk of oxidative stress induced lung injury from these particles, compared with the young organism. Results also show that ultrafine particle effects can be significantly enhanced by a gaseous co-pollutant such as ozone. The studies performed so far support the ultrafine particle hypothesis. Additional studies are necessary to evaluate mechanistic pathways of responses.