PPFE is a recognised association with collagen vascular diseases (CVD), hypersensitivity pneumonitis (HP) and post-transplant, but not recognised with occupational exposures. As the CT changes of PPFE can be confused with chronic sarcoidosis and silicosis a full lifetime occupational and environmental history is standard practice in our ILD MDT. We have reviewed those discussed in 2021-2 with a definite (with lung histology) or probable (MDT consensus opinion) diagnosis of PPFE, categorised into those with at least one first degree relative affected with fibrotic ILD, a definite collagen vascular disease, evidence of asbestos exposure , HP and others. 5/20 had significant asbestos exposure >20 years before presentation. 2 were in high exposure categories (carpenter and bricklayer), one was an office worker who for 13 years mixed Artex (containing asbestos) in her garage every morning for her husband who was an Artex plasterer, one washed her builder husband?s overalls for 23 years and one warehouse operative with pleural plaques (also familial). 13/19 were lifelong non-smokers, and a further 2 had smoked <1 pack-year, different from the prevalence of smoking in IPF, suggesting that the aetiology of PPFE differs from IPF and that asbestos exposure be added to the causes. An asbestos JEM would have missed 3/5.