Brad,
Just to clarify...
It had low power and produced grey smoke before you changed the fuel filter?
If yes, then you might try some of these:
Check the fuel pressure (after the fuel filter - usually at the Schrader valve where the fuel line goes into the VP44 Fuel Injection Pump).
Replace the air filter.
Replace the coolant temperature sensor.
Replace the MAP sensor.
You said it's intermittent...
Is he able to tie the behavior to any particular operating condition... like it only behaves this way when the engine is cold or hot, etc. That might help everyone come up with more suggestions.
Are there any Diagnostic Trouble Codes being reported? If he doesn't have a code reader, he can try this: Turn ignition key on, off, on, off, on (and leave on) then write down all the codes that are displayed in the odometer window. When Pdone and Edone are displayed, turn the ignition off.
Good luck,
John L.