Rationale: Exposure to arsenic through drinking water has been linked to respiratory symptoms, obstructive lung diseases, and mortality from respiratory diseases. Limited evidence for the deleterious effects on lung function exists among individuals exposed to a high dose of arsenic. Objectives: To determine the deleterious effects on lung function that exist among individuals exposed to a high dose of arsenic. Methods: In 950 individuals who presented with any respiratory symptom among a population-based cohort of 20,033 adults, we evaluated the association between arsenic exposure, measured by well water and urinary arsenic concentrations measured at baseline, and post-bronchodilator-administered pulmonary function assessed during follow-up. Measurements and Main Results: For every one SD increase in baseline water arsenic exposure, we observed a lower level of FEV 1 (246.5 ml; P , 0.0005) and FVC (253.1 ml; P , 0.01) in regression models adjusted for age, sex, body mass index, smoking, socioeconomic status, betel nut use, and arsenical skin lesions status. Similar inverse relationships were observed between baseline urinary arsenic and FEV 1 (248.3 ml; P , 0.005) and FVC (255.2 ml; P , 0.01) in adjusted models. Our analyses also demonstrated a dose-related decrease in lung function with increasing levels of baseline water and urinary arsenic. This association remained significant in never-smokers and individuals without skin lesions, and was stronger in male smokers. Among male smokers and individuals with skin lesions, every one SD increase in water arsenic was related to a significant reduction of FEV 1 (274.4 ml, P , 0.01; and 2116.1 ml, P , 0.05) and FVC (272.8 ml, P ¼ 0.02; and 2146.9 ml, P ¼ 0.004), respectively. Conclusions: This large population-based study confirms that arsenic exposure is associated with impaired lung function and the deleterious effect is evident at low-to moderate-dose range.Keywords: arsenic exposure; lung function; Bangladesh Arsenic from drinking water has been linked with cancers, dermatologic, cardiovascular, reproductive, and neurotoxic outcomes among adults and children (1-8). Chronic exposure to arsenic has also been linked to nonmalignant respiratory effects including respiratory symptoms, chronic obstructive pulmonary disease, and respiratory disease mortality (9-12). However, the evidence of the effect of arsenic exposure on lung function is limited, especially at the low-to moderate-dose ranges. Several studies from arsenic-endemic areas of South Asia reported lower FEV 1 and FVC among individuals with arsenical skin lesions or drinking water with very high levels of arsenic (.250 mg/L) (13-15). Interestingly, a recent retrospective study from Chile identified that those exposed to arsenic either in utero or early life had a lower FEV 1 (11.5%; P ¼ 0.04) and FVC (12.2%; P ¼ 0.04) in adulthood compared with those unexposed (16).The published studies measuring pulmonary function involved small sample sizes and most lacked individual-level exposure data or measured arseni...