To evaluate the usefullness of a portable peak flow meter in predicting airway dysfunction in symptomatic swine confinement workers, we conducted a study using an established cohort of swine workers in Iowa. Participants were randomly selected from a group of 207 swine confinement workers and a group of nonconfinement farmers who had been followed longitudinally. Swine confinement workers with work-related symptoms were identified, and two control groups (swine confinement workers and nonconfinement workers) without work related symptoms were frequently matched by age, sex, and smoking status to the symptomatic swine confinement workers. Peak flow measuers were obtained for 7 days using a mini-Wright peak flow meter and comparisons were made between the symptomatic swine confinement farmers (n=24) and both groups of asymptomatic workers: swine confinement workers (n=21) and neighbourhood farmer controls (n=25). Peak flow readings were recorded by subject five times per day for 7 days, initially on awakening, then after chores, before lunch, before dinner, and before bedtime. The actual hour of day for each measurement of peak flow was similar between the three groups. Percent changes from initial AM peak flow did not significantly differ between subject groups. However, symptomatic swine confinement workers consistently exhibited significantly lower initial and subsequent mean peak flow values compared with asymptomatic swine confinement workers and neighborhood control farmers, controlling for age, height, gender and smoking status. These differences occurred on most of the measures of peak flow throughout the work day. The persistence of these lower values throughout the work day is remarkably consistent during the study period and is suggestive of airway disease in the symptomatic swine confinement workers. Our findings suggest that peak flow meters are a useful indicator of potential airway injury and offer an additional portable, diagnostic tool in the assessment of sympotmatic workers.