American Board of Internal Medicine (ABIM) Certification Practice Exam

What FEV1 level is indicative of GOLD 4 COPD diagnosis?

1. Less than 50% of predicted

2. Less than 30% of predicted

3. Between 30% and 40% of predicted

4. Between 40% and 50% of predicted

The correct answer is: Less than 30% of predicted

A diagnosis of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 4 COPD is characterized by a very severe obstructive pattern on pulmonary function tests. Specifically, a forced expiratory volume in one second (FEV1) that is less than 30% of the predicted value is required for this classification. This level signifies significant airway limitation and is associated with severe shortness of breath, exacerbations, and a higher risk of comorbid conditions and mortality. In patients classified under GOLD 4, the reduced FEV1 indicates critical lung function impairment, which has profound implications for the patient's quality of life and medical management. The other levels of FEV1 outlined in the options represent less severe grades of COPD, including GOLD 3, which is defined by an FEV1 between 30% and 50% of the predicted value, and GOLD 2, which is indicated by an FEV1 between 50% and 80% of predicted. Understanding these thresholds is essential for the accurate staging and appropriate treatment planning for patients with COPD.