title: Decline in FEV(1) in community-based older volunteers with higher levels of neutrophil elastase in bronchoalveolar lavage fluid.
abstract: BACKGROUND
  Neutrophil elastase (NE) is thought to be one of the key proteinases in the development of chronic obstructive pulmonary disease (COPD). Previously, we have shown that the NE-alpha1-proteinase inhibitor (NE-alpha1PI) complex in bronchoalveolar lavage (BAL) fluid was markedly elevated in asymptomatic smokers who had subclinical emphysema on CT scans. We proposed that excessive NE-alpha1PI complex in BAL fluid was a factor which might differentiate smokers who were developing emphysema from others.
  
  
  OBJECTIVE
  In this study, we addressed the question of whether elevated levels of the NE-alpha1PI complex in BAL fluid are linked to the accelerated decline in pulmonary functions in those subjects.
  
  
  METHODS
  We conducted a follow-up study to analyze the decline in FEV(1) for 4.3 years on average for 26 community-based volunteers who had received pulmonary function tests, CT scans and BAL. The levels of the NE-alpha1PI complex in BAL fluid and in plasma was measured.
  
  
  RESULTS
  Neither pulmonary function measurements nor the presence of emphysema on CT scans could predict the decline in FEV(1). The number of inflammatory cells in BAL fluid was also not an indicator of progression. By contrast, subjects with higher levels of the NE-alpha1PI complex in BAL fluid had a significantly accelerated decline in FEV(1) compared to those with lower levels.
  
  
  CONCLUSIONS
  These data seem to support the hypothesis that NE in the lung is related to the onset and/or progression of COPD.
authors.affiliation: First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan. tbetsuya@pulmonary.wustl.edu
authors.forename: T
authors.initials: T
authors.lastname: Betsuyaku
authors.forename: M
authors.initials: M
authors.lastname: Nishimura
authors.forename: K
authors.initials: K
authors.lastname: Takeyabu
authors.forename: M
authors.initials: M
authors.lastname: Tanino
authors.forename: K
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Kawakami
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D019272:Leukocyte Elastase / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011656:Pulmonary Emphysema / Q000175:diagnosis* / Q000503:physiopathology; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D019272:Leukocyte Elastase