The diurnal variation in peak expiratory flow rate (PEFR) was studied in 26 mixers from eight factories making polyurethane foam, who were exposed to toluene diisocyanate (TDI), and 26 unexposed controls matched for age, race, and smoking. They were all men. The mean diurnal variation in PEFR of the mixers was 6.2%, which was significantly higher than the 4.3% for controls. Six mixers had a diurnal variation of greater than 15% on at least one day compared with none among the controls. There was, however, no overt cause of occupational asthma. All but one of the 24 environmental samples taken exceeded the short term exposure limit of 0.02 ppm for TDI. This accounted for the high prevalence (50%) of irritative symptoms such as cough and eye irritation. Forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity (FVC) (%) was negatively correlated with duration of exposure to TDI. Foam workers may still have high exposure to TDI, high prevalence of irritative symptoms, increased diurnal variation in PEFR and evidence of chronic airway obstruction, particularly in those with greater than or equal to 10 years of exposure.
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