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Evidence was synthesized narratively and classified as direct COPD-specific clinical evidence, indirect human pulmonary evidence, animal-model evidence, or mechanistic evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Infections with helminths and protozoa may influence the pathophysiology of COPD by modulating the type 1 immune response through type 2 polarization, expansion of regulatory T cells, eosinophilia, systemic immune activation, and alterations to the microbiome. These mechanisms may influence inflammatory phenotypes and exacerbation susceptibility. Direct COPD-specific evidence is limited. Most support derives from pulmonary parasitic disease, observational studies, animal models, or mechanistic inference. Clinically, parasitic eosinophilia may confound COPD phenotyping, and occult\n                      <jats:italic toggle=\"yes\">Strongyloides stercoralis<\/jats:italic>\n                      infection is particularly important when systemic corticosteroids are considered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current evidence supports a biologically possible role for parasitic infections as modifiers of COPD immunopathology, but does not establish causality or routine parasite-driven COPD. Prospective, phenotype-stratified studies integrating parasitological and immunological analyses are required, particularly in endemic populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03946320261490459","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:37:22Z","timestamp":1792773442000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Parasitic infections as immunomodulatory modifiers of chronic obstructive pulmonary disease"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5016-616X","authenticated-orcid":false,"given":"Sandra","family":"Grumelli","sequence":"first","affiliation":[{"name":"Research Department, CIMeR Centro de Investigacion en Medicina Respiratoria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Global strategy for prevention diagnosis and management of COPD","author":"GOLD Report","year":"2024","unstructured":"GOLD Report. 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