American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the gold standard for diagnosing COPD?

1. Chest X-ray

2. Patient history and physical examination

3. Spirometry measuring FEV1 and FVC

4. Arterial blood gas analysis

The correct answer is: Spirometry measuring FEV1 and FVC

The gold standard for diagnosing Chronic Obstructive Pulmonary Disease (COPD) is spirometry, which measures forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Spirometry allows healthcare providers to assess the lung function of a patient quantitatively. In COPD, there is a characteristic obstruction to airflow, which is evidenced by a reduced FEV1 relative to the FVC. A significant finding in COPD is a post-bronchodilator FEV1/FVC ratio of less than 0.70, indicating persistent airflow limitation. This method is preferred because it not only confirms the presence of airflow obstruction but also assesses the severity of the disease and can help guide treatment decisions. While patient history and physical examination, chest X-rays, and arterial blood gas analysis can provide valuable information in the assessment of respiratory patients, none offer the specific and objective assessment of airflow limitation that spirometry does. Therefore, spirometry stands as the most definitive test for the diagnosis of COPD.