COPD patients receiving ICS/LABA and LAMA triple therapy had higher serum MMP-9 (958.7 ng/ml [95% CI 737.3–1198.6]) and a higher MMP-9/TIMP-1 ratio (3.8 [95% CI 3.1–5]) compared with COPD patients receiving bronchodilator therapy (MMP-9, 726.7 ng/ml [95% CI 473.7–889.4]; MMP-9/TIMP-1 ratio, 3 [95% CI 2.1–3.4]). Here, TIMP1 is linked to chronic obstructive pulmonary disease.