A regression approach to the analysis of serial peak flow among fuel oil ash exposed workers

We investigated the association between exposure to fuel oil ash and acute airway obstruction in 31 boilermakers and 31 utility workers during the overhaul of a large oil-fired boiler. Air flow was assessed with self-recorded serial peak expiratory flow rate measurements (PEFR) using a mini-Wright meter. Exposure to thoracic particulates with an aerodynamic diameter of 10 gm or smaller (PM10) was assessed using personal sampling devices and detailed work diaries. All subjects were male, with an average age of 43 yr, and an average of 18 yr at their current trade. Average PM10 exposure on work days was 2.75 mg/m3 for boilermakers and 0.57 mg/m3 for utility workers. Three daily PEFR measurements (start-of-shift, end-of-shift, and bed-time) were analyzed simultaneously, using Huber linear regression. After adjustment for job title, welder status, age, height, smoking, and weld-years, for each mg/m3 increase in PM10, the estimated decline in PEFR was 13.2 L/min (p = 0.008) for end-of-shift, 9.9 L/min (p = 0.045) for bed-time, and 6.6 L/min (p = 0.26) for start-of-shift of the following day. This decline of the exposure effect over the 24-h period that follows was statistically significant (p = 0.004). No other factors were found to significantly modify the effect of exposure. Our results suggest that occupational exposure to fuel oil ash is associated with significant acute decrements in peak flow.