Possible Alternate Explanation for Cases of Idiopathic Pulmonary Fibrosis.

To the Editor:

In their paper on idiopathic pulmonary fibrosis (IPF) among U.S. veterans, Kaul and colleagues may have missed another set of factors possibly leading to an incorrect diagnosis among those found to have IPF (1). Exposure to various dusts, including asbestos, has been well documented as looking both radiologically and pathologically like IPF.

It would have been of interest to examine if navy veterans, most likely to have had significant exposure to asbestos, had a higher rate of disease than members of other services.

Also, from the map provided in the paper, three states with extensive mining activities, Montana, Kentucky, and West Virginia, had among the highest rates of IPF reported. This raises the question of the possible role of pneumoconiosis-producing dusts as being a possible more correct reason for the fibrotic changes.

This highlights what seems to be a true lack of consideration of such occupational exposures as an explanation of this and also other medical findings.