Which description best characterizes pink puffers (emphysema) among COPD presentations?

• A. Pink puffer features prominent dyspnea with minimal cough and scant sputum
• B. Blue bloater features prominent dyspnea with productive cough
• C. Pink puffer shows cyanosis and edema
• D. Blue bloater has little dyspnea

Answer: (A)

Pink puffers are the emphysema phenotype of COPD. The hallmark is prominent dyspnea that is out of proportion to exam, with little or no productive cough and only scant sputum. These patients are often thin from the increased work of breathing and air trapping leads to hyperinflation. Their oxygenation tends to be relatively preserved early on, so they usually look pink rather than blue and edema is not typical. This contrasts with the blue bloater (chronic bronchitis), who characteristically has a productive cough with substantial sputum, cyanosis from chronic hypoxemia, and often peripheral edema due to cor pulmonale. So the description that best fits pink puffers is the one noting marked dyspnea with minimal cough and scant sputum.