Idiopathic Hyperplasia of Pulmonary Neuroendocrine Cells

To the Editor: The report of Aguayo et al. (Oct. 29 issue) 1 concerning “idiopathic” diffuse hyperplasia of pulmonary neuroendocrine cells associated with airway disease hypothesizes that these cells underwent primary hyperplasia. Although a small subgroup of patients may fit this hypothesis, many may have identifiable reasons for chronic hypoxia (and thus probably secondary hyperplasia, a phenomenon well described in the carotid body). How many of the patients described were residents of Denver? The authors themselves cite the study by Gould et al. documenting neuroendocrine hyperplasia in the lungs of 6 of 20 Bolivian natives who were long-term dwellers at high . . .