Chronic obstructive pulmonary disease (COPD) is characterized by the degradation of elastin, the major insoluble protein of lung tissues. The degradation of elastin gives rise to desmosine (DES) and isodesmosine (IDES), two major urinary products typified by a hydrophilic pyridinium-based crosslinker structure. A high sensitivity method based on nanoflow liquid chromatography tandem mass spectrometry with multiple reaction monitoring was developed for the analysis of urinary DES and IDES. The analytes were derivatized with propionic anhydride and deuterated DES (D 4 -DES) was used as an internal standard. This method enables the quantification of DES and IDES in as little as 50 µL of urine and provides a detection limit of 0.10 ng/mL (0.95 fmol on-column). We report the analysis of DES and IDES in a cohort of 40 urine specimens from four groups of individuals: (a) COPD rapid decliners (11.8 ± 3.7 ng/mg creatine (crea)), (b) COPD slow decliners (16.0 ± 3.1 ng/ mg crea), (c) healthy smokers (13.2 ± 1.9 ng/mg crea), and (d) healthy nonsmokers (14.9 ± 2.9 ng/ mg crea). Our analysis reveals a statistically significant decrease in the level of urinary DES and IDES in COPD rapid decliner patients compared to healthy nonsmoker controls and COPD slow decliner patients. This methodology may be useful for monitoring DES and IDES levels in well controlled animal models for COPD or for longitudinal studies in COPD patients.Chronic obstructive pulmonary disease, or COPD, is a respiratory disorder generally caused by smoking. 1-3 Two major forms of COPD are emphysema and chronic bronchitis. 3 COPD is characterized by impaired lung function, inflammation and scarring of bronchial tubes, and degradation of elastin-containing tissues. The elastin is a major protein component of insoluble fibers providing elastic properties to tissues such as lung, skin, and blood vessels. 4 Also, elastin peptides were reported to be chemotactic for neutrophils and macrophages and could play a role in the progression of pulmonary emphysema once elastin degradation is initiated. 5,6 Most of the COPD biomarkers reported in the literature are cross-linkers 1,7,8 released during the elastin breakdown. The two most abundant and studied elastin crosslinkers are desmosine (DES) and isodesmosine (IDES) 9,10 ( Figure 1). For simplicity, in this report DESs refer to both DES and IDES. DESs are pyridinium-based structural isomers arising from the