Hepatocyte growth factor activator inhibitor-1 (HAI-1) is a Kunitz-type transmembrane serine proteinase inhibitor that inhibits trypsin-like serine proteinases, such as hepatocyte growth factor activator, matriptase, hepsin and prostasin. HAI-1 is expressed in polarized epithelial cells, in which HAI-1 is mainly located on the basolateral membrane. In the present study, we analyzed the expression and distribution of HAI-1 in respiratory epithelium. We found that HAI-1 is expressed by the bronchial respiratory epithelium with basal or basolateral localization and also by the alveolar epithelium. Bronchial expression of HAI-1 was also confirmed using cultured human bronchial epithelial cells. The epithelial expression of HAI-1 was augmented in response to tissue injury such as cancer invasion and inflammation. Surprisingly, in the injured pulmonary tissue, HAI-1 showed distinct apical translocation in ciliated epithelial cells of the bronchiole. We suggest that, in addition to its basolateral surface localization, HAI-1 can transiently localize to the apical surface of respiratory ciliated epithelial cells under conditions of severe inflammation, possibly interacting with a specific cellular proteinase on the apical surface.