Page 43:..."In the more advanced stages of emphysema, the patient exhalesaudibly with his lips pursed, and uses his
accessory respiratory muscles prominently. But because there is no severe large airway obstruction to disrupt gas
exchange, oxygen and carbon dioxide levels remain normal and his complexion is rosy.  From their pursed- lip breathing
and healthy color these patients are described as "pink puffers"....His chances will rise dramatically (to develop heart troubles), however, if coexisting chronic bronchitis becomes more widespread and severe. Then he will become
chronically hypoxic (low oxygen level in blood)....

In these more advanced stages (of chronic bronchitis), the difficulty in maintaining an adequate oxygen level in the
blood sometimes gives a bluish-gray tinge to the patient's skin.  Progressive withdrawal from physical activity over the
years has turned the majority of these patients flabby and overweight.  Their typical skin color and physique have led
to the descriptive term of "blue bloaters""---
Somewhere in the text the author says, that these terms are not used anymore because they are not covering correctly
the complicated picture of COPD.

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People who have a dificiency of oxygen in the blood from the lungs and may or may not have "swelling" in the feet, ankles and/or
other parts of the body from "water retention in the body tissue", often suffering from congestive heart failure.  There is a blueness to
their skin coloring, thus the term "Blue Bloater".
Basically these terms are medical "slang" and are quite broad and that is why they are not used much anymore.
 
 
 

edited on 9-19-1999