Blue Bloater and Pink Puffer in COPD: Why Doctors Once Used Those Terms

Chronic obstructive pulmonary disease (COPD) is a group of diseases, including chronic bronchitis and emphysema, that block your airways and make it hard for you to breathe.

Today, doctors understand what causes these conditions and know more about how to treat them. This wasn’t always the case.

In the past, doctors used the terms “blue bloater” and “pink puffer” to refer to types of COPD patients. These terms described stereotypes of some of the physical symptoms of COPD.

They’re not considered accurate or respectful by today’s standards, but you might still see them in older medical texts.

What did “blue bloater” mean?

The term “blue bloater” was used in the past to refer to patients with chronic bronchitis.

Doctors referred to these patients as “blue bloaters” because chronic bronchitis can cause severe difficulty breathing and decreased oxygen in the body. This can result in a patient’s skin and lips taking on a blueish tint.

Sometimes, these patients also had overweight or obesity. Patients with chronic bronchitis often have a chronic cough and are unable to get enough oxygen in their bodies even when they try to take deep breaths.

What did “pink puffer” mean?

The term “pink puffer” was used in the past to refer to patients with emphysema. Doctors used this term because emphysema causes people to have difficulty catching breath.

As a result, patients gaps or take short, fast breaths. This often causes them temporary redness or pink coloring on their cheeks and faces.

Why the terms aren’t used anymore

Today, neither of these terms are used by doctors. There are several reasons for this change.

One primary reason is that these terms were based on the stereotypes of how these conditions physically looked. This makes it very likely people with less severe or less typical signs, and symptoms could be overlooked and misdiagnosed.

This type of language is demeaning for patients and unhelpful to medical professionals. It doesn’t describe what’s happening in a person’s body or why it’s happening.

COPD, chronic bronchitis, and emphysema are much better understood today. Doctors now know that many people with COPD have both chronic bronchitis and emphysema. This makes the old separation of “blue bloaters” and “pink puffers” even less useful.

What is chronic bronchitis?

Chronic bronchitis occurs when the airways in your lungs become inflamed. The primary cause of chronic bronchitis is smoking cigarettes, although causes like air pollution and a family history of bronchitis can sometimes also lead to the condition.

There’s no cure for chronic bronchitis, but you can manage it with treatment and lifestyle changes.

Symptoms

The symptoms of chronic bronchitis can be easily confused with other conditions like asthma or upper respiratory tract infections. The condition can develop slowly. You might have symptoms like chronic cough for years before you begin having trouble breathing or chest discomfort.

It’s always best to see a healthcare professional about any cough that lasts for longer than a week or two.

Common symptoms include:

• chronic cough
• cough the produces mucus
• wheezing
• discomfort or pain in your chest
• shortness of breath

Diagnosis

The first step to a chronic bronchitis diagnosis is a medical appointment. Your healthcare professional will go over your symptoms and your medical history. Any history of smoking will be especially important. You might need to have a few tests done to confirm your diagnosis.

The most common tests to diagnose chronic bronchitis are tests of how well your lungs are working. These are called pulmonary function tests. You’ll take the tests by breathing into a machine that measures and monitors how well your lungs inhale and exhale.

Other tests might include X-rays, CT scans, and bloodwork.

Read this article for more information about how COPD is diagnosed.

Treatment

The treatment for chronic bronchitis is a combination of lifestyle changes and medical treatments. Your exact treatment plan will depend on how severe your chronic bronchitis is and how well you respond to treatment. Chronic treatments include:

• stopping smoking
• using a humidifier at home
• saying away from irritants and smoke in the air
• taking prescription oral medications to clear your airways
• using inhaled medications to clear your airways
• using portable oxygen to help your body get enough oxygen
• attending pulmonary rehabilitation to help manage your breathing

What is emphysema?

Emphysema is a slow-developing lung disease that occurs when the tiny air sacs in your lung tissue called alveoli become damaged. Over time, this damage causes the alveoli to rupture and create one large air sac. This traps air and makes it difficult for you to breathe.

The primary cause of emphysema is smoking, but it can also be caused by air pollution and repeated respiratory infections.

Symptoms

Since emphysema develops slowly, it’s common for people to have the condition for years before any symptoms occur. Shortness of breath is normally the first symptom to appear.

People often mistake the shortness of breath caused by emphysema as simply being out of shape. But as emphysema progresses, shortness of breath can occur even when you’re at rest.

Diagnosis

Your healthcare professional will discuss your medical history and your symptoms at your appointment. They’ll likely ask about any history of smoking or exposure to secondhand smoke.

You might also have tests to confirm the diagnosis. This might include tests of how well your lungs function.

These tests are called pulmonary function tests and will require you to breathe into a small device. The device will measure how much oxygen you’re able to get when you breathe. You might also have imaging tests to look inside your lungs and rule out other causes of shortness of breath.

Treatment

Your treatment for emphysema will likely be a combination of therapy, medications, and self-care strategies. The right plan for you will depend on how well you respond to treatment and on how far your emphysema has progressed.

Possible treatments include:

• maintaining a moderate weight
• quitting smoking
• taking prescription oral medications to clear your airways
• using inhaled medications to clear your airways
• using supplemental oxygen
• attending pulmonary rehabilitation to help you control your breathing
• having surgery to remove damaged lung tissue

The bottom line

In the past, the terms “blue bloater” and “pink puffer” were used to describe COPD. “Blue bloater” referred to chronic bronchitis, and “pink puffer” referred to emphysema.

These terms described some of the stereotypical physical features people with these conditions sometimes have. Now that these conditions are better understood, these terms are considered demeaning and unhelpful.

Today, doctors use the terms chronic bronchitis or emphysema for a more accurate and appropriate diagnosis.

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