These included pulmonary and activation-regulated chemokine (PARC/CCL-18), surfactant protein D (SP-D) and tissue inhibitor of metalloproteinase (TIMP-1), as well as the proportion of nature killer (NK) cells, nature killer T (NKT) cells and CD8+ T-lymphocytes, all of which are associated with COPD exacerbations. Here, CCL18 is linked to chronic obstructive pulmonary disease.