{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T20:19:41Z","timestamp":1784146781455,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","issue":"6360","license":[{"start":{"date-parts":[[1983,1,15]],"date-time":"1983-01-15T00:00:00Z","timestamp":411436800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1983,1,15]]},"abstract":"<jats:p>Breathlessness, disability, and exercise tolerance were assessed in 26 patients with severe chronic airflow limitation (forced expiratory volume in one second (FEV1) less than or equal to 1 litre) divided into two groups--15 patients who were normocapnic (pressure of arterial carbon dioxide (Paco2) less than 5.5 kPa (less than 41.4 mm Hg)), and 11 patients who were hypercapnic (Paco2 greater than 6 kPa (greater than than 45.1 mm Hg)). The two groups were well matched for spirometric values (FEV1 0.59 1 and 0.62 1, respectively). All of the hypercapnic patients could improve blood gas tensions towards normal by hyperventilation. There were no significant differences in visual analogue scores of breathlessness during treadmill exercise, disability (oxygen-cost diagram, dyspnoea grade), or exercise tolerance (six-minute walk, maximal consumption of oxygen during bicycle ergometry, distance walked to exhaustion in progressive treadmill test). The findings show that the \"fight\" to maintain normal blood gas tensions in the face of severe airflow limitation does not have an appreciable cost in terms of disability.<\/jats:p>","DOI":"10.1136\/bmj.286.6360.179","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"179-182","source":"Crossref","is-referenced-by-count":13,"title":["Are \"pink puffers\" more breathless than \"blue bloaters\"?"],"prefix":"10.1136","volume":"286","author":[{"given":"M A","family":"Johnson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A A","family":"Woodcock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Rehahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D M","family":"Geddes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1983,1,15]]},"reference":[{"key":"ref_1","first-page":"1185","article-title":"Respiratory insufficiency","volume":"i:","author":"IDornhorst, A.C.","year":"1955","unstructured":"IDornhorst AC. Respiratory insufficiency. Lancet 1955;i:1185-6.","journal-title":"Lancet"},{"key":"ref_2","first-page":"524","author":"In, Reid L.","year":"1980","unstructured":"Reid L. In: Fishman AP, ed. Pulmonary diseases and disorders. New York: McGraw Hill, 1980:524."},{"key":"ref_3","first-page":"473","article-title":"Thoracic medicine","author":"Emerson, P.","year":"1981","unstructured":"Emerson P, ed. Thoracic medicine. London: Butterworths, 1981:473."},{"key":"ref_4","first-page":"125","article-title":"Regulation of breathing part II","volume":"72","author":"Forster, H.V.","year":"1981","unstructured":"Forster HV, Dempsey JA. In: Hornbein TF, ed. Regulation of breathing part II. New York: Marcel Dekker, 1981:ch 13. (Lung biology in health and disease. Series. Vol 17.) 5Robin ED, O'Neill RP. The fighter versus the non-fighter. Control of ventilation in chronic obstructive lung disease. Arch Environ Health 1963;72:125-7.","journal-title":"Arch Environ Health; ch 13. (Lung biology in health and disease. Series. Vol 17.) 5Robin ED, O'Neill RP. The fighter versus the non-fighter. Control of ventilation in chronic obstructive lung disease"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/0022-3999(81)90066-0","article-title":"Psychological approaches to breathlessness and its treatment","volume":"25","author":"Rosser, R.; Guz, A.","year":"1981","unstructured":"Rosser R, Guz A. Psychological approaches to breathlessness and its treatment. _7 Psychosom Res 1981;25:439-47.","journal-title":"_7 Psychosom Res"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1136\/bmj.281.6250.1232-a","article-title":"Centrally acting drugs in chronic airways obstruction","volume":"281","author":"Anonymous","year":"1980","unstructured":"Anonymous. Centrally acting drugs in chronic airways obstruction. Br MedJ 1980;281:1232-3.","journal-title":"Br MedJ"},{"key":"ref_7","first-page":"242","article-title":"Diazepam and breathlessness","volume":"ii:","author":"Anonymous","year":"1981","unstructured":"Anonymous. Diazepam and breathlessness. Lancet 1981;ii:242-3.","journal-title":"Lancet"},{"key":"ref_8","first-page":"39","article-title":"Pulmonary gas exchange during exercise in patients with chronic airway obstruction","volume":"31","author":"Jones, N.L.","year":"1966","unstructured":"Jones NL. Pulmonary gas exchange during exercise in patients with chronic airway obstruction. Clin Sci 1966;31:39-50.","journal-title":"Clin Sci"},{"key":"ref_9","first-page":"179","article-title":"The relationship between central carbon dioxide sensitivity and clinical features in patients with chronic airways obstruction","volume":"46","author":"Matthews, A.W.","year":"1977","unstructured":"Matthews AW. The relationship between central carbon dioxide sensitivity and clinical features in patients with chronic airways obstruction. Q 7 Med 1977;46:179-95."},{"key":"ref_10","article-title":"Lung function: assessment and application in medicine","author":"Cotes, J.E.","year":"1975","unstructured":"Cotes JE. Lung function: assessment and application in medicine. 3rd ed. Oxford: Blackwell Scientific, 1975.","edition":"3rd ed"},{"key":"ref_11","first-page":"\"263","article-title":"Arterialised earlobe blood samples for blood gas tensions. BrJ7 Dis Chest","volume-title":"Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. Br MedJ","volume":"70","author":"Spiro, S.G.; Dowdeswell, I.R.G.","year":"1976","unstructured":"Spiro SG, Dowdeswell IRG. Arterialised earlobe blood samples for blood gas tensions. BrJ7 Dis Chest 1976;70:263-8. '3 McGavin CR, Artvinli M, Naoe H, McHardy GJR. Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. Br MedJ' 1978;ii:241-3."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1056\/NEJM198112313052703","article-title":"Breathlessness and exercise tolerance in subjects with airways obstruction and normal blood gases: the effects of dihydrocodeine, alcohol and caffeine","volume":"305","author":"Woodcock, A.A.; Gross, E.R.; Gellert, A.; Shah, S.; Geddes, D.M.","year":"1981","unstructured":";284:1607-8.","journal-title":"N Engl Jr Med"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/S0140-6736(81)91612-3","article-title":"Oxygen relieves breathlessness in pink puffers","volume":"i:","author":"Woodcock, A.A.; Gross, E.R.; Geddes, D.M.","year":"1981","unstructured":"Woodcock AA, Gross ER, Gellert A, Shah S, Geddes DM. Breathlessness and exercise tolerance in subjects with airways obstruction and normal blood gases: the effects of dihydrocodeine, alcohol and caffeine. N Engl Jr Med 1981;305:1611-6.","journal-title":"Lancet"},{"key":"ref_14","article-title":"Breathlessness in man: measurement and modification","author":"thesis, Woodcock AA. MD","year":"1982","unstructured":"Woodcock AA, Gross ER, Geddes DM. Oxygen relieves breathlessness in pink puffers. Lancet 1981;i:907-9."},{"key":"ref_15","first-page":"14","article-title":"Clinical types of chronic obstructive lung disease in London and in Chicago","volume":"90","author":"Burrows, B.; Niden, A.H.; Fletcher, C.M.; Jones, N.","year":"1964","unstructured":"Woodcock AA. MD thesis. Breathlessness in man: measurement and modification. University of Manchester, 1982.","journal-title":"Am Rev Resp Dis"},{"key":"ref_16","first-page":"1","article-title":"American emphysema and British bronchitis","volume":"90","author":"Fletcher, C.M.; Jones, N.L.; Burrows, B.; Niden, A.H.","year":"1964","unstructured":"Burrows B, Niden AH, Fletcher CM, Jones N. Clinical types of chronic obstructive lung disease in London and in Chicago. Am Rev Resp Dis 1964;90: 14-27.","journal-title":"Am Rev Resp Dis"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/S0002-9343(70)80109-7","article-title":"Exercise performance in relation to the pathophysiologic type of chronic obstructive pulmonary disease. AmJ'","volume":"49","author":"Marcus, J.H.; McLean, R.L.; Duffell, G.M.; Ingram, R.H.","year":"1970","unstructured":"Fletcher CM, Jones NL, Burrows B, Niden AH. American emphysema and British bronchitis. Am Rev Resp Dis 1964;90:1-13.","journal-title":"Med"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/0002-9343(68)90234-9","article-title":"Chronic obstructive bronchopulmonary disease: II oxygen transport in two clinical types","volume":"44","author":"Filley, G.F.; Beckwitt, B.J.; Reeves, J.T.; Mitchell, R.S.","year":"1968","unstructured":"Marcus JH, McLean RL, Duffell GM, Ingram RH. Exercise performance in relation to the pathophysiologic type of chronic obstructive pulmonary disease. AmJ' Med 1970;49:14-2 1.","journal-title":"Am J Med"},{"issue":"40","key":"ref_19","first-page":"8","article-title":"Psychological factors and beliefs affecting exercise tolerance in chronic bronchitis","volume":"63","author":"Morgan, A.D.; Peek, D.F.; Buchanan, D.; McHardy, G.J.R.","year":"1982","unstructured":"Filley GF, Beckwitt BJ, Reeves JT, Mitchell RS. Chronic obstructive bronchopulmonary disease: II oxygen transport in two clinical types. Am J Med 1968;44:26-37.","journal-title":"Clin Sci; The dyspnogenic effect of hypoxiadissociation from ventilatory response"},{"key":"ref_20","article-title":"Accepted","year":"1982","unstructured":"Morgan AD, Peek DF, Buchanan D, McHardy GJR. Psychological factors and beliefs affecting exercise tolerance in chronic bronchitis. Clin Sci 1982;63:40P. 23 Adams L, Chronos N, Guz A. The dyspnogenic effect of hypoxiadissociation from ventilatory response. Clin Sci 1982;63:17P. 24 Guz A, Adams L, Minty K, Murphy K. Breathlessness and the ventilatory drives of exercise, hypercapnia and hypoxia. Clin Sci 1981;60:17p-1 8p."},{"key":"ref_21","article-title":"Of the 262 Asians seen in a large survey of Rochdale Asians,2 90 hailed from the Lahore and Rawalpindi area of Pakistan. These subjects were interviewed by AR and TM and contact addresses of relatives in Pakistan obtained. During a subsequent visit to Pakistan in the summer of 1981 attempts were made to trace these relatives and to solicit their help with the study. In the event, 92 indigenous Pakistanis (48 male, 44 female) were investigated. Nineteen of these were first-degree relatives of immigrants to Britain, and the remaining 73 were recruited from among the neighbours of relatives declining to take part in the study. The median age of these subjects was 29 years. There was one 11-year-old, and the remainder ranged from 14 to 75 years. They were considered to be highly representative of the community from which the Asian immigrants to Britain had originated. Of the 92 subjects, 31 were villagers and 61 were city dwellers","unstructured":"(Accepted 27 October 1982)"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.286.6360.179","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.286.6360.179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T20:03:07Z","timestamp":1765310587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.286.6360.179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1983,1,15]]},"references-count":21,"journal-issue":{"issue":"6360","published-online":{"date-parts":[[1983,1,15]]},"published-print":{"date-parts":[[1983,1,15]]}},"alternative-id":["10.1136\/bmj.286.6360.179"],"URL":"https:\/\/doi.org\/10.1136\/bmj.286.6360.179","relation":{},"ISSN":["0007-1447","1468-5833"],"issn-type":[{"value":"0007-1447","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1983,1,15]]}}}