CORRESPONDENCE Combined

pulmonary fibrosis and emphysema in patients exposed to agrochemical compounds To the Editors: In the very interesting article concerning the clinical syndrome resulting from combined pulmonary fibrosis and emphysema (CPFE) published in the European Respiratory Journal, COTTIN et al. [1] speculated that both emphysema and fibrosis might be related to a common environmental trigger and/or genetic factor, with tobacco exposure playing a central role. Here, we report our clinical experience of the same syndrome in order to emphasise the possible role of environmental exposure in the pathogenesis of the disease. Over the last 2 yrs, 41 patients with pulmonary fibrosis were investigated in our teaching hospital in Greece, which is located in the middle of a large rural area. In total, 21 cases fulfilled the criteria for th