What Are Blue Bloaters and Pink Puffers, and How Can Nurse Triage Address Them?

Blue bloaters and pink puffers are two terms that were adopted back in the 1950s to describe two phenotypes (observable symptoms) of patients suffering from chronic obstructive pulmonary disease (COPD). Specifically, blue bloaters referred to chronic bronchitis, while pink puffers meant emphysema. Since that time, physicians have transitioned away from using these terms. Read on to learn why, and how telephone nurse triage can help patients understand their symptoms.

Blue Bloaters and Pink Puffers Only Refer to Visible Symptoms

As Medical News Today notes, these names are no longer relevant when addressing either condition. 

Why? 

The terms “blue bloaters” and “pink puffers” only focus on visible symptoms, rather than underlying causes. They also don’t address atypical symptoms for these conditions. Finally, they don’t account for patients who display symptoms of both conditions.

What Is Chronic Bronchitis?

Chronic bronchitis is the condition where the lining of the bronchial tubes becomes inflamed. These tubes are responsible for carrying air into and out of the lungs. As these airways become irritated, mucus forms and makes it difficult for patients to breathe. This lack of oxygen can lead to cyanosis, or the blue coloring that affects skin, lips, or nails — thus, blue bloaters. 

Beyond this blue coloring, a lack of oxygen also puts an increased strain on patients’ hearts, which can eventually result in right-sided heart failure and edema (swelling).

What Are the Symptoms of Chronic Bronchitis?

While we already mentioned cyanosis, other symptoms of chronic bronchitis to be mindful of include:

• An airway flow problem.
• A recurrent productive cough.
• Hypoxia.
• Hypercapnia.
• Respiratory acidosis.
• High hemoglobin.
• An increased respiratory rate.
• Dyspnea on exertion.
• Digital clubbing.
• Cardiac enlargement.
• Bilateral lower extremity edema.

What Is Emphysema?

Emphysema is the condition where the alveoli (small air sacs in the lungs where oxygen and carbon dioxide are exchanged) are irreversibly damaged due to cigarette smoke or other inhaled chemicals and particulates. This damage also leads to air becoming trapped inside the alveoli, which makes it difficult for patients to exhale. The reason that patients suffering from emphysema used to be referred to as pink puffers is because they’re more likely to take shorter, faster breaths, resulting in temporary redness on their cheeks and faces.

What Are the Symptoms of Emphysema?

Patients with emphysema typically exhibit symptoms like:

• A thin appearance.
• Increased CO₂ retention.
• Minimal cyanosis.
• Pursed lip breathing.
• Dyspnea.
• Exertional dyspnea.
• Hyperresonance on chest percussion.
• Orthopnea.
• Prolonged expiratory time.
• Speaking in jerky sentences due to shortness of breath.
• Anxiety.
• Accessory muscle use for breathing.

Long-Term Health Risks

Now that you know where blue bloaters and pink puffers come from, let’s explore why these conditions can be so harmful.

As we mentioned above, emphysema and chronic bronchitis both contribute to COPD, which is now the sixth leading cause of death in the United States. This is because, while primarily restricting airflow, COPD can also lead to lung cancer, heart disease, and other life-threatening conditions. 

How is COPD Diagnosed?

Providers will obtain health histories for patients that detail any smoking habits or exposure to other forms of air pollution, dust, and chemicals. Tests can include spirometry, X-rays, and arterial blood gas (measuring oxygen levels in the blood, and how well the body exchanges it with carbon dioxide).

How Is COPD Treated?

This disease is currently incurable, which means people with COPD can only be treated for their symptoms. There are several treatments that may be administered to patients, including:

• Bronchodilators to improve airflow.
• Pulmonary rehabilitation to strengthen the lungs.
• Oxygen therapy to supplement what the body cannot diffuse naturally.
• Corticosteroids to reduce inflammation.
• Antibiotics to kill bacterial infections.
• Daliresp (drug) to prevent flare-ups.
• Flu or pneumonia vaccines to avoid severe infection.

Triage Options to Help Patients

Patients who are struggling with chronic bronchitis, emphysema, or COPD can look to nurse triage solutions to help them manage their conditions.