American Board of Internal Medicine (ABIM) Certification Practice Exam

What characterizes moderate persistent asthma in terms of symptoms?

1. Daily symptoms with nighttime awakenings once a week

2. Symptoms only during exercise

3. Symptoms occurring less than twice a week

4. Daily symptoms with nighttime awakenings more than once a week

The correct answer is: Daily symptoms with nighttime awakenings more than once a week

Moderate persistent asthma is characterized by daily symptoms that significantly impact a patient's quality of life and can interfere with daily activities. A key feature of this level of asthma severity is the frequency of nighttime awakenings, which often occur more than once a week. This aspect indicates that the asthma is not well-controlled, as patients frequently experience disturbances in their sleep due to their symptoms. In moderate persistent asthma, patients typically experience symptoms such as wheezing, chest tightness, shortness of breath, and coughing on most days. Nighttime awakenings more than once a week further emphasize the chronicity and severity of the condition, indicating that the asthma requires more intensive management, often involving the use of daily medication to help control the inflammation and bronchoconstriction typical of this category. The other options do not adequately capture the characteristics of moderate persistent asthma. For example, experiencing symptoms only during exercise would be more consistent with exercise-induced asthma rather than persistent asthma. Similarly, symptoms occurring less than twice a week would typically fall into the mild intermittent or mild persistent categories rather than moderate persistent, where daily occurrences along with frequent nighttime symptoms are expected.