August 19, 2023

What is a Blue Bloater?

Until recently, healthcare professionals often divided people with COPD into two groups based on their physical appearance and the types of symptoms they experienced: the pink puffers – who have chronic bronchitis and normal oxygen saturation – and the blue bloaters – who have emphysema and decreased oxygen saturation. Unfortunately, these classic subtypes are based on stereotypes and may lead to misdiagnoses and missed opportunities for treatment.

Emphysema is a type of COPD that occurs due to the gradual damage and destruction of the air sacs in the lungs, called alveoli. Normally, these alveoli are elastic, inflating and deflating as a person breathes in and out. However, when a person has emphysema, the walls of the alveoli are damaged, leading to fewer and larger alveoli with reduced surface area. This can result in chronic cough, wheezing, shortness of breath, edema and cyanosis.

In a recent study, researchers used COPDGene to identify 10,300 current and former smokers with a diagnosis of COPD and performed inspiratory chest computed tomography (CT) scans that passed quality control. Among patients with COPD, the classic pink puffer - blue bloater distinction is no longer useful and was not found to be related to the severity of airflow obstruction (FEV1/FVC) (see Figure 1).

In the future, doctors may use a different system for categorizing COPD based on the severity of lung damage, rather than on the patient’s symptom patterns. Ultimately, this will make diagnosing and managing COPD easier for physicians and improve patient outcomes. If you have COPD, book an appointment today with a healthcare professional and discuss the best treatment plan for you.


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