ELANE and pulmonary emphysema: We previously reported that the neutrophil elastase-alpha1-protenase inhibitor (NE-alpha1PI) complex in bronchoalveolar lavage fluid was markedly elevated in asymptomatic smokers who had subclinical emphysema on CT scans20; furthermore, higher levels of the NE-alpha1PI complex were associated with accelerated decline in FEV121.