“Blue bloater” and “pink puffer” are terms doctors once used to describe and distinguish types of people with chronic obstructive pulmonary disease (COPD). The terms described stereotypes of some physical symptoms of COPD.

Healthcare professionals use the term COPD to refer to two chronic lung conditions: emphysema and bronchitis. A person with COPD may experience one or both conditions, which cause breathing difficulties and airflow blockage.

COPD affects about 16 million people in the United States. Many more Americans may have COPD and be unaware of it. There is no cure for COPD, but a healthcare professional can recommend treatments to alleviate a person’s symptoms.

This article defines the outdated terms “pink puffer” and “blue bloater” and explains why healthcare professionals no longer use them. It also discusses what emphysema and bronchitis are and when someone should speak with a doctor.

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In the 1950s, health experts used the terms “blue bloater” and “pink puffer” to refer to two classical phenotypes of individuals with severe COPD. A phenotype is a set of observable attributes or characteristics of an individual.

Blue bloater

“Blue bloater” is an outdated term for people with chronic bronchitis. People with this condition may have a persistent cough, increased mucus production, and shortness of breath due to inflammation of the airways.

Doctors may have referred to people as “blue bloaters” because they experienced cyanosis, which is when a person’s skin, fingernail beds, and lips become a bluish color, usually due to hypoxia. Additionally, many of these individuals may have been overweight or living with obesity.

Finally, healthcare professionals may have referred to some people as “blue bloaters” because they also had swollen ankles and large veins in the neck, which are signs of cor pulmonale. COPD is the most common cause of cor pulmonale.

Pink puffer

Doctors used to refer to people with emphysema as “pink puffers.” People with emphysema typically find it difficult to catch their breath, which means they may take short, fast breaths or gasp. This fast, labored breathing may cause their skin to appear red or pink temporarily.

As their COPD worsens, individuals with emphysema may also experience weight loss as a result of using more energy to breathe and systemic inflammation.

Medical professionals no longer use the terms “blue bloater” and “pink puffer” to refer to people with COPD for several reasons.

Firstly, the terms were based on stereotypes of how people with emphysema and bronchitis appeared physically. The terms did not refer to the underlying causes of the conditions and were therefore unhelpful to medical professionals and demeaning to people with the conditions.

Additionally, because the terms were based on the stereotypes of how these conditions physically looked, people with less typical or severe symptoms of COPD may have been overlooked or misdiagnosed by healthcare professionals.

Finally, an individual with COPD may display multiple phenotypes of the condition. This means someone with COPD may have both emphysema and chronic bronchitis, so the separation of “blue bloaters” and “pink puffers” was not helpful.

Emphysema is a form of COPD that occurs due to gradual damage to the air sacs in the lungs, which doctors call alveoli. Typically, these air sacs are elastic, inflating and deflating when a person breathes in and out.

When a person has emphysema, the walls between many of the alveoli are damaged, causing the alveoli themselves to lose their shape and become floppy. In some cases, the damage can destroy the alveoli walls, causing fewer and larger alveoli instead of many tiny alveoli.

The reduced surface area in the lungs makes gas exchange and breathing difficult. Gas exchange is when the lungs move oxygen in and carbon dioxide out of the body.

Symptoms may not appear until the disease gets worse. They may include:

  • frequent coughing and wheezing, which is a high pitched whistling sound while breathing
  • productive cough
  • shortness of breath, especially after exercise
  • chest tightness

Chronic bronchitis refers to inflammation and irritation of the airways, or bronchi, in the lungs. This causes mucus to build up in the lungs and makes it harder to breathe.

A cough is the most common symptom of chronic bronchitis. A healthcare professional may diagnose someone with chronic bronchitis if a productive cough is present for 3 months within 2 years.

Other symptoms may include malaise and those associated with excessive coughing, such as chest or abdominal pain.

COPD has no cure, but it is often treatable and preventable. Identifying COPD early may help prevent lung function decline and reduce the burden of symptoms, significantly improving a person’s quality of life.

Millions of people in the United States have COPD, but many more may have the condition without knowing it. Therefore, a person should speak with a healthcare professional if they experience any symptoms of COPD, including chronic bronchitis and emphysema.

Many people ignore or do not recognize the symptoms of COPD, which may include:

  • persistent coughing
  • shortness of breath, especially during day-to-day activities
  • frequent respiratory infections
  • cyanosis
  • excessive mucus production
  • wheezing
  • fatigue

People with COPD should also speak with a healthcare professional if their symptoms worsen or do not improve with treatment.

“Pink puffer” and “blue bloater” were terms that doctors once used to describe two phenotypes of people with COPD. Healthcare professionals no longer use these terms due to their inaccuracy and because they are demeaning to people with COPD.

Emphysema and chronic bronchitis are obstructive lung conditions that fall under the umbrella of COPD. They are both preventable and treatable.

A person should speak with a healthcare professional if they recognize any symptoms of COPD. People with COPD should report any worsening symptoms to their doctor or discuss any treatments that are not helping with their symptoms.