Extracellular proteolysis is hypothesized to be the major cause of pulmonary emphysema and oxygen-derived free radicals and neutrophil elastase are thought to play an important role in its pathogenesis. In this study, peripheral polymorphonuclear leukocytes (PMNs) obtained from 16 patients with emphysema generated a significantly larger amount of superoxide and elastase activity than those obtained from normal controls. A significant correlation was observed between elastase activity and superoxide release. In addition, the superoxide release showed a negative correlation with the disease duration. The superoxide release appeared to correlated with a decline of FEV1.0 over the course of several years in 8 patients. It seems likely that activated PMNs play an important role in the development of pulmonary emphysema.