A previous study showed that patients with COPD had excessive cutaneous elastin loss, which related to increased cutaneous elastolytic activity, emphysema severity, and arterial stiffness.28 Therefore, the possibility of a systemic elastin degradation pathology contributing to the pulmonary and vascular features associated with COPD is raised28 although other mechanisms, such as the effects of hypoxia, may also be important. Here, ELN is linked to pulmonary emphysema.