A "pink puffer" is a person where emphysema is the primary underlying pathology.

As you recall, emphysema results from destruction of the airways distal to the
terminal bronchiole--which also includes the gradual destruction of the pulmonar
y capillary bed and thus decreased inability to oxygenate the blood. So, not onl
y is there less surface area for gas exchange, there is also less vascular bed f
or gas exchange--but less ventilation-perfusion mismatch than blue bloaters. The
body then has to compensate by hyperventilation (the "puffer" part). Their arte
rial blood gases (ABGs) actually are relatively normal because of this compensat
ory hyperventilation. Eventually, because of the low cardiac output, people affl
icted with this disease develop muscle wasting and weight loss. They actually ha
ve less hypoxemia (compared to blue bloaters) and appear to have a "pink" comple
xion and hence "pink puffer". Some of the pink appearance may also be due to the
work (use of neck and chest muscles) these folks put into just drawing a breath
.
A "blue bloater" is a person where the primary underlying lung pathology is chro
nic bronchitis. Just a reminder, chronic bronchitis is caused by excessive mucus
production with airway obstruction resulting from hyperplasia of mucus-producin
g glands, goblet cell metaplasia, and chronic inflammation around bronchi. Unlik
e emphysema, the pulmonary capillary bed is undamaged. Instead, the body respond
s to the increased obstruction by decreasing ventilation and increasing cardiac
output. There is a dreadful ventilation to perfusion mismatch leading to hypoxem
ia and polycythemia. In addition, they also have increased carbon dioxide retent
ion (hypercapnia). Because of increasing obstruction, their residual lung volume
gradually increases (the "bloating" part). They are hypoxemic/cyanotic because
they actually have worse hypoxemia than pink puffers and this manifests as bluis
h lips and faces--the "blue" part.