American Board of Internal Medicine (ABIM) Certification Practice Exam

Which group of patients should be considered for pulmonary rehabilitation in COPD?

1. All patients with FEV1 > 50%

2. Asymptomatic patients

3. Patients with FEV1 less than 50% who are symptomatic

4. Patients who refuse medical therapy

The correct answer is: Patients with FEV1 less than 50% who are symptomatic

Patients with COPD and an FEV1 less than 50% who are symptomatic are prime candidates for pulmonary rehabilitation. The rationale for this is rooted in the multifaceted approach needed to manage COPD effectively. Patients with more advanced disease often experience significant limitations in their exercise capacity and daily activities due to symptoms such as shortness of breath or fatigue. Pulmonary rehabilitation is designed to improve these patients' functional status, enhance their quality of life, and decrease their symptoms through a structured program that includes exercise training, education on disease management, and nutritional and psychological support. The rehabilitation programs have been shown to improve the efficiency of the respiratory muscles, increase overall endurance, and provide strategies for coping with breathlessness. While patients with FEV1 greater than 50% may also benefit, particularly if they have persistent symptoms, the strongest recommendations typically focus on those with worse lung function and appreciable symptoms, as they are at a higher risk for complications and more likely to gain significant benefits from rehabilitation. Asymptomatic patients and those who refuse medical therapies generally do not meet the criteria for pulmonary rehabilitation as their needs and benefits differ significantly from those who are symptomatic and have more severe disease.