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Aims: To determine if usual interstitial pneumonia pattern fibrosis is seen in asbestosis METHODS AND RESULTS: The occurrence of usual interstitial pneumonia pattern fibrosis was studied in 4 asbestos cohorts systematically referred following post mortem to the U.K. Pneumoconiosis Unit, Cardiff. The combined exposed workforce was over 25,000 persons. Over the 17 year period 233 subjects were identified, 210 had degrees of interstitial fibrosis with a fibrotic non-specific interstitial pneumonia pattern and sub-pleural accentuation and 3 cases showed usual interstitial pneumonia pattern fibrosis. All 3 cases showed grade 4 fibrosis (honeycombing) with no asbestos fibre dose-response correlation. Poisson distribution of probability analysis indicated that the observed cases of usual interstitial pneumonia in this workforce could be wholly accounted for by the prevalence of idiopathic pulmonary fibrosis in the population CONCLUSIONS: Usual interstitial pneumonia pattern fibrosis is rarely observed in asbestos exposed subjects, shows no dose-response correlation with asbestos fibres on mineral analysis and this points to the alternate disease such as idiopathic pulmonary fibrosis. The results indicate that usual interstitial pneumonia pattern fibrosis should not be regarded as bonafide asbestosis, irrespective of the status of asbestos biomarkers and this impacts upon the post mortem handling of asbestos related deaths. This article is protected by copyright. All rights reserved.