Are "pink puffers" more breathless than "blue bloaters"?

Johnson, Margaret; Woodcock, Ashley; Rehahn, M.; Geddes, Duncan M.

doi:10.1136/bmj.286.6360.179

Cited by 18 publications

(10 citation statements)

References 16 publications

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“…This airflow limitation may be caused by both inflammation and wall thickening in small airways, which is responsible for the narrowing of the airway lumens, and in some but not all cases, parenchymal destruction of the lungs (emphysema), leading to loss of the elastic lung recoil 2. Traditionally, on the basis of determined clinical, functional, and radiologic features, patients with COPD used to be classified into 2 different biotypes: the “blue boater”, in association with a predominant chronic bronchitis condition, and the “pink puffer”, identified as predominant emphysema 3. However these are only the two extreme phenotypes among the broad variety of clinical presentations in COPD.…”

Section: Introductionmentioning

confidence: 99%

“… 2 Traditionally, on the basis of determined clinical, functional, and radiologic features, patients with COPD used to be classified into 2 different biotypes: the “blue boater”, in association with a predominant chronic bronchitis condition, and the “pink puffer”, identified as predominant emphysema. 3 However these are only the two extreme phenotypes among the broad variety of clinical presentations in COPD.…”

Section: Introductionmentioning

confidence: 99%

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Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression

Martín

Ramos²,

Lόpez-Campos³

et al. 2011

COPD

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BackgroundMore accurate phenotyping of COPD is of great interest since it may have prognostic and therapeutic consequences. We attempted to explore the possible relationship between the extent of emphysema, as assessed by high-resolution computed tomography (HRCT), and COPD severity. We also included some study variables involving exercise tolerance evaluation and peripheral muscle strength (PMS) measurement.MethodsSixty-four patients with COPD (mean age 64 ± 7 years) were enrolled in a prospective observational cross-sectional study. All patients underwent clinical and functional evaluations: assessment of dyspnea, body mass index (BMI), health status assessment, spirometry testing, and arterial blood gas analysis. The extent of emphysema was graded using HRCT. Functional capacity was evaluated by a cardiopulmonary maximal exercise testing (CPET), the shuttle walking test, and by estimation of PMS.ResultsHalf of the study patients had an emphysematous phenotype. There was a significant correlation between the score derived from analysis of HRCT images and BMI and respiratory functional parameters, as well as VO2 max (maximal oxygen uptake) and chest pull 1RM (1 rep max). Compared with subjects with a nonemphysematous phenotype, those with an emphysematous phenotype showed a lower BMI, a reduced PMS, and displayed a lower power at CPET. Significant differences in lung function tests were found for diffusing capacity and hyperinflation. No significant differences in quality of life were observed between the two study groups.ConclusionsCompared with subjects with a nonemphysematous phenotype, subjects with an emphysematous phenotype has a different profile in terms of BMI, lung function, PMS, and exercise capacity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression

Martín

Ramos²,

Lόpez-Campos³

et al. 2011

COPD

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“…Computed tomography (CT) has been instrumental in identifying COPD sub-phenotypes, such as airway disease (bronchitis and bronchiolitis) and parenchymal destruction (emphysema), the relative contribution of which varies from patient to patient. This classification is not new since classically, the "blue bloaters" and the "pink puffers" 10 were considered the two most common phenotypes of COPD, but with the premise that they could overlap each other. Recent basic and translational studies have highlighted some major differences in the pathobiology of emphysema versus chronic bronchitis, such that they are now thought to be two different entities and not two manifestations of the same disease.…”

Section: The Many Faces Of Copd Emphysema Versus Airway Diseasementioning

confidence: 99%

The Many Faces of Chronic Obstructive Pulmonary Disease: Moving Towards Precision Medicine

Polverino¹

2021

BRN

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When the term chronic obstructive pulmonary disease (COPD) was first used in 1970s, it included two main phenotypes: the "blue bloater" (chronic bronchitis) and "pink puffer" (emphysema). Recently, as our current knowledge on the disease has progressed, the attention has been drawn to very diverse subtypes of chronic airflow obstruction characterised by different causes, age of onset, pathological and clinical manifestations. Over the years, "recommendations" have been generated for the clinicians on how to manage the patients with COPD, such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Although the GOLD recommendations had the great merit to draw attention onto the COPD severity and its clinical management, they are now less suitable to address the extremely diverse nature of COPD. This review will give an overview of the history of COPD, and the many faces of COPD over the years to date. (BRN Rev. 2019;5(2):90-103)

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“…Traditionally, on the basis of specific clinical, functional, and radiological features, patients with COPD used to be classified into different biotypes, ie, the “blue bloater,” in association with predominantly chronic bronchitis, and the “pink puffer,” identified as predominantly emphysema 43. However, these are only two extreme phenotypes among a broader spectrum of clinical presentations in COPD.…”

Section: Use Of Cluster Analysis To Define Potential Copd Phenotypesmentioning

confidence: 99%

Use of cluster analysis to describe desaturator phenotypes in COPD: correlations between pulmonary function tests and nocturnal oxygen desaturation

Toraldo¹,

Nuccio²,

Gaballo³

et al. 2011

COPD

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BackgroundSignificant heterogeneity of clinical presentation and disease progression exists within chronic obstructive pulmonary disease (COPD). Although forced expiratory volume in 1 second (FEV1) inadequately describes this heterogeneity, a clear alternative has not emerged. This article discusses and refines the concept of phenotyping desaturators in COPD and shows a possible pattern which could be used as a framework for future research.Recent findingsCOPD is a complex condition with pulmonary and extrapulmonary manifestations. We suggest that COPD phenotypes should be associated with clinically meaningful outcomes. The innovation of COPD phenotyping is defined as COPD desaturators. Sleep-related hypoxemia and hypercapnia are well recognized in COPD and the development of systemic inflammation during sleep. These sleep-related changes predispose to nocturnal cardiac arrhythmias, pulmonary hypertension, and possibly death, particularly during acute exacerbations.ConclusionA more focused definition makes possible a classification of patients into two distinct subgroups for both clinical and research purposes. Establishing a common language for future research will facilitate our understanding and management of such diseases. Even if different treatment strategies have different outcomes for these groups, we will have confirmation, or otherwise, of the clinical value of cluster analysis. This knowledge could lead to pharmacological treatment and other interventions directed to specific phenotypic groups.

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Are "pink puffers" more breathless than "blue bloaters"?

Cited by 18 publications

References 16 publications

Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression

Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression

The Many Faces of Chronic Obstructive Pulmonary Disease: Moving Towards Precision Medicine

Use of cluster analysis to describe desaturator phenotypes in COPD: correlations between pulmonary function tests and nocturnal oxygen desaturation

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