COPD: Bronchitis vs Emphysema

[pistachio]

So I've been wondering, if chronic bronchitis and emphysema are both obstructive diseases with a V/Q mismatch, why are bronchitis patients cyanotic ("blue bloaters") and emphysema patients are not?

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[theunderdog]

So I've been wondering, if chronic bronchitis and emphysema are both obstructive diseases with a V/Q mismatch, why are bronchitis patients cyanotic ("blue bloaters") and emphysema patients are not?

they both are blue boaters. both have cyanosis. both have barrel chests (aka truck driver chest). and both have pursed lips. im not sure why FA separate them like that.

 

[agranulocytosis]

they both are blue boaters. both have cyanosis. both have barrel chests (aka truck driver chest). and both have pursed lips. im not sure why FA separate them like that.

This is incorrect. Pure emphysema patients are pink puffers because the obstruction is at the distal terminal bronchiole, thereby allowing exodus of CO2 from unaffected alveoli. Pure chronic bronchitis patients are blue bloaters because the obstruction is more proximal to that point, thereby inhibiting mass exodus of CO2 from otherwise normal alveoli.

 

[osli]

Emphysema classically produces the pink puffer, who is thin with barrel chest, pursed lips, dyspneic, and with normal PaCO2.

Chronic bronchitis classically produces the blue bloater, who is obese, edematous, cyanotic, and happy with increased PaCO2.

Smoking generally produces a mixture of the two to some degree, and you can have emphysema patients become blue bloaters and chronic bronchitis patients become pink puffers. Genetics seems to play some role in who will become which, but the above associations are much stronger than the opposite and worth remembering for the exam.