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Limited evidence exists on the effects of arsenic (As) exposure on non-malignant pulmonary outcomes, particularly among those exposed to low-to-moderate levels of As or without skin lesions. In a population-based study, using follow-up data in the Health Effects of Arsenic Longitudinal Study (HEALS) cohort, we found that As exposure from drinking water was significantly related to increased incidence of chronic obstructive lung diseases, and pulmonary tuberculosis and respiratory infections in children. We have also observed As induced immune modulation in the same population.