From the book of Chronic bronchitis and Emphysema Handbook by Dr.F.Haas:

Page 43:...".In the more advanced stages of emphysema,the patient exhales audibly 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 ptients 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 his 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
tipical skin color and physique have led to the descriptive term of "blue bloaters"---
Somewhere in the text the author says, that this terms are not used anymore because they are not covering
correctly the complicated picture of COPD.

People who are able to maintain enough oxygen in the bloodstream through an  "increase in their
breathing rate"  keep more of a normal coloring to their skin ( however they are almost always SOB.)
thus they are called  "Pink Puffers"
Some people fall somewhere in between these two catagories in various degrees.

 Basically these terms are medical "slang" and are quite broad and that
is why they are not used much anymore.


edited on September 19, 1999