The association between increased MMP-9 and productive cough among subjects with COPD shown here contribute, together with previous reports from selected study populations [9,36,37], to the hypothesis that MMP-9 may be involved in the disease process in COPD-subjects with bronchitis symptoms and a history of frequent exacerbations, or the ‘exacerbating-bronchitis’ phenotype [38]. This evidence concerns the gene MMP9 and bronchitis.