American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with COPD, pulmonary rehabilitation is recommended for those with an FEV1 of what percentage or less?

1. 40% of predicted

2. 50% of predicted

3. 60% of predicted

4. 70% of predicted

The correct answer is: 50% of predicted

Pulmonary rehabilitation is a critical component of the management of chronic obstructive pulmonary disease (COPD) and is particularly beneficial for patients with more severe disease. The recommendation for commencing pulmonary rehabilitation generally aligns with the severity of airflow limitation as determined by the forced expiratory volume in one second (FEV1). The guideline suggests that patients with an FEV1 of 50% of predicted or less should be considered for pulmonary rehabilitation. This recommendation is based on evidence indicating that individuals with moderate to severe COPD experience significant benefits from such programs, including improvements in exercise capacity, health-related quality of life, and a reduction in symptoms. Patients whose FEV1 is at or below this threshold often have impaired lung function that limits their overall activity levels and contributes to significant morbidity. Therefore, enrolling these patients in pulmonary rehabilitation can lead to tailored exercise training, nutritional advice, and education, all of which are designed to help them manage their condition more effectively. In summary, the recommendation for pulmonary rehabilitation in COPD patients with an FEV1 of 50% of predicted or less is grounded in the clinical understanding that these individuals are at a greater risk of functional decline and may derive substantial benefit from a structured rehabilitation program.