- What This Credential Actually Is
- Who Qualifies to Sit for the Exam
- Exam Format, Scoring, and What 180 Means
- Fees, Registration, and Test-Center Logistics
- The 19-Domain Content Outline
- High-Yield Topics Inside the Heaviest Domains
- Sequencing Your Prep by Domain
- Reading the Pass-Rate Data Honestly
- After You Pass: Continuing Certification and Careers
- Frequently Asked Questions
- Certification in Pediatric Pulmonology is issued by the American Board of Pediatrics and delivered through Prometric, with roughly 200 multiple-choice...
- The passing score is a scaled 180 on a 1-300 scale, not a raw percentage of items correct.
- The outline effective November 1, 2026 has 19 domains; Asthma is the largest at 9%.
- Latest verified first-time national pass rate: 73% in 2024, up from 68% in 2022.
What This Credential Actually Is
Certification in Pediatric Pulmonology is the American Board of Pediatrics (ABP) subspecialty credential for physicians who have completed fellowship training in the diagnosis and management of respiratory disease in infants, children, and adolescents. It is a board certification, not a course certificate, and it sits on top of general pediatrics certification. If you are still sorting out terminology, our explainers on what Pediatric Pulmonology certification is and what the specialty itself covers give useful background.
The examination is administered at Prometric testing centers. Because the ABP updates its blueprint periodically, the version that matters for you is the one tied to your exam date. The current content outline takes effect November 1, 2026 and applies to the initial-certification examination scheduled for November 5, 2026. The October 2025 subboard approval date you may see referenced is not the effective date, which is a common point of confusion among candidates reading older summaries.
Who Qualifies to Sit for the Exam
The traditional eligibility pathway has four components:
- A medical or osteopathic degree
- Certification in general pediatrics
- Completion of a three-year subspecialty fellowship in pediatric pulmonology
- Fulfillment of the scholarly activity requirements attached to fellowship
Current license and attestation details, and how any announced new training model applies to your situation, require direct confirmation with the ABP. Do not rely on a program coordinator's memory or a forum post for this; training-model changes are exactly the type of detail that shifts between cohorts. For a fuller walkthrough, see our guide to Pediatric Pulmonology requirements and how to qualify, and for a look at what fellowship itself involves, our overview of Pediatric Pulmonology training.
Notice that Domain 19, Core Knowledge in Scholarly Activities and Health Equity, mirrors the scholarly requirement. The board is signaling that research literacy is part of what it certifies, not an administrative afterthought. Fellows who treated their scholarly project as a box to check often find that biostatistics and study-design questions feel unfamiliar on exam day.
Exam Format, Scoring, and What 180 Means
The examination consists of approximately 200 multiple-choice questions. Expect clinical vignettes: a child with a presenting complaint, selected history, exam findings, and sometimes a pulmonary function tracing, chest imaging description, or lab result, followed by a question about the best next step, most likely diagnosis, underlying mechanism, or most appropriate therapy.
The passing standard is a scaled score of 180 on a 1-300 scale. This is not a raw percentage, and candidates should resist the urge to translate it into "I need to get X% right." Scaled scoring accounts for differences in form difficulty, so the number of items you must answer correctly can vary from one form to another. Our deeper treatment is in the passing score guide.
Fees, Registration, and Test-Center Logistics
The official indexed regular fee is $2,992, which includes a $750 processing component. Fee structures can change by cycle and registration window, so the ABP's published fee page is the final word. For a broader view of what to budget beyond the exam fee itself, see our certification cost breakdown.
| Item | What We Can Verify |
|---|---|
| Certifying body | American Board of Pediatrics (ABP) |
| Test delivery | Prometric |
| Regular fee | $2,992 (includes $750 processing) |
| Question count | Approximately 200 multiple-choice |
| Passing standard | Scaled score of 180 on a 1-300 scale |
| Upcoming initial exam | November 5, 2026 |
| Remote, open-book, calculator, break rules | Unverified; confirm with ABP |
Scheduling windows and deadlines are covered in our exam dates and scheduling guide. The practical advice: register early, confirm your exam date against the official dates page, and read the Prometric center instructions well before test day rather than the night before.
The 19-Domain Content Outline
The outline effective November 1, 2026 divides the exam into 19 domains whose approximate published weights total 100%. Here is the full map:
| Domain | Name | Approx. Weight |
|---|---|---|
| 1 | Lung Development and Physiology | 6% |
| 2 | Common Signs and Symptoms | 8% |
| 3 | Respiratory Disorders of the Neonate and Infant | 5% |
| 4 | Congenital and Acquired Malformations of the Airways and Lungs | 5% |
| 5 | Respiratory Infections | 6% |
| 6 | Cystic Fibrosis (CF) | 6% |
| 7 | Non-CF Bronchiectasis | 4% |
| 8 | Asthma | 9% |
| 9 | Sleep-Disordered Breathing and Control of Breathing Disorders | 4% |
| 10 | Restrictive Disease | 5% |
| 11 | Respiratory Failure | 5% |
| 12 | Interstitial Lung Disease | 5% |
| 13 | Pulmonary Vascular and Lymphatic Diseases | 4% |
| 14 | Lung Disease Associated with Systemic Disorders | 4% |
| 15 | Environmental Injuries and Exposures (Acute and Chronic) | 4% |
| 16 | Respiratory System Under Stress | 3% |
| 17 | Other Disorders of the Respiratory System | 5% |
| 18 | Core Principles of Pulmonary Diagnosis and Monitoring Techniques | 8% |
| 19 | Core Knowledge in Scholarly Activities and Health Equity | 4% |
Two things stand out. First, the distribution is flat: no single domain exceeds 9%, so there is no safe domain to skip. Second, the two "method" domains, Common Signs and Symptoms (8%) and Core Principles of Pulmonary Diagnosis and Monitoring Techniques (8%), together carry 16%, nearly twice the weight of Asthma. Candidates who study only disease entities leave a lot on the table. Our complete domains guide expands on each area.
High-Yield Topics Inside the Heaviest Domains
The ABP publishes domain names and weights; it does not publish item-level topic lists in the form of a guarantee. The topics below are what a candidate can reasonably expect to master given each domain's scope, so treat them as a study scaffold rather than a prediction of specific questions.
Domain 8: Asthma (9%)
The largest single domain rewards both pathophysiology and stepwise management reasoning.
- Phenotypes and endotypes, and how they inform biologic therapy selection
- Stepping therapy up and down, including controller choice by age band
- Differentiating asthma from its mimics: vocal cord dysfunction, tracheomalacia, foreign body, aspiration
- Interpreting spirometry and bronchodilator response in the context of control assessment
- Environmental triggers, comorbid conditions, and adherence barriers
Domain 2: Common Signs and Symptoms (8%)
This domain tests clinical reasoning from presentation: chronic cough, wheeze, stridor, hemoptysis, cyanosis, exercise intolerance, and recurrent infection.
- Building a differential by age: what a wet cough means at 18 months versus 14 years
- Recognizing red flags that should redirect you to a structural, genetic, or immunologic cause
- Choosing the next diagnostic step with the least invasive yield
Domain 18: Core Principles of Pulmonary Diagnosis and Monitoring Techniques (8%)
Expect questions on how tests work, when they mislead, and what they cost the patient.
- Pulmonary function testing across ages, including infant PFTs and quality criteria
- Bronchoscopy, bronchoalveolar lavage interpretation, and imaging selection
- Sleep studies and gas-exchange monitoring
- Interpreting flow-volume loops and lung volumes in obstructive versus restrictive patterns
Domain 6: Cystic Fibrosis (6%)
CF is a staple of the specialty, and questions often span genetics, microbiology, nutrition, and modulator therapy together.
- CFTR variant classes and which modulators apply
- Newborn screening follow-up and diagnostic confirmation
- Pulmonary exacerbation management and airway microbiology
- Extrapulmonary complications and their monitoring
Do not neglect the smaller domains. Lung Development and Physiology (6%) underpins how you reason about nearly everything else, from chronic lung disease of prematurity to the physiologic basis of restrictive and obstructive patterns. Respiratory Infections (6%) is high-frequency clinical content, and Respiratory Disorders of the Neonate and Infant (5%) connects to the neonatal origins of many chronic conditions you will see in clinic.
Key Takeaway
Because the weights are flat and the domains interlock, the efficient strategy is to learn mechanisms that cross domains, such as how developmental lung biology explains both neonatal disease and later restrictive physiology, rather than memorizing 19 isolated lists.
Sequencing Your Prep by Domain
This is the one place we will talk about study structure, and it is tied directly to the outline. The logic: start with foundations that every other domain depends on, then move through disease-heavy domains, and reserve the final stretch for the method-heavy and scholarly domains plus timed practice. The calendar below assumes roughly an eight-week runway; compress or stretch it to fit your own timeline. For a broader plan, see our Pediatric Pulmonology study guide.
Foundations and Presentation
- Domain 1: Lung Development and Physiology
- Domain 2: Common Signs and Symptoms
- Domain 3: Respiratory Disorders of the Neonate and Infant
- Why first: development and symptom-based reasoning feed every later domain
The Big Chronic Diseases
- Domain 8: Asthma
- Domain 6: Cystic Fibrosis
- Domain 7: Non-CF Bronchiectasis
- Domain 5: Respiratory Infections
Structural, Parenchymal, and Systemic
- Domains 4, 10, 11, 12, 13, and 14
- Domain 9: Sleep-Disordered Breathing and Control of Breathing Disorders
- Pair restrictive disease with interstitial lung disease to compare patterns
Methods and Exposures
- Domain 18: Core Principles of Pulmonary Diagnosis and Monitoring Techniques
- Domains 15, 16, and 17
- Practice reading PFT and imaging descriptions under time pressure
Scholarly Content and Full-Length Practice
- Domain 19: Scholarly Activities and Health Equity
- Timed blocks of mixed questions, then review of every miss by domain
A quick reference sheet helps in the last days; our one-page cheat sheet is built for that, and you can pressure-test your recall with questions on the main practice test site. Tracking misses by domain tells you where the next study hour should go.
Reading the Pass-Rate Data Honestly
The latest verified first-time national pass rate is 73% for 2024, compared with 68% in 2022, as reported in a 2026 primary paper citing ABP data. Those are the only pass-rate figures we can stand behind, and they are first-time national rates, not a guarantee of anything about your own attempt.
A few cautions apply. Two data points do not establish a trend, so avoid concluding the exam is "getting easier." First-time pass rates also reflect a candidate pool that is already highly selected: board-certified general pediatricians who completed a three-year fellowship. That context matters if you are trying to judge difficulty from the number alone. We unpack this further in our pass rate analysis and difficulty guide.
After You Pass: Continuing Certification and Careers
Initial certification is the beginning of a maintenance cycle, not the end of one. Continuing certification runs on a five-year cycle, and diplomates can use either MOCA-Peds or an examination pathway to demonstrate ongoing knowledge. Confirm the details of both options with the ABP, since program mechanics are updated periodically.
On the career side, pediatric pulmonologists work in children's hospitals, academic medical centers, and specialty clinics, often combining inpatient consults, outpatient asthma and CF care, sleep medicine, bronchoscopy, and chronic ventilation programs. Hiring tends to concentrate in academic and children's-hospital settings where multidisciplinary programs exist. We deliberately do not quote a salary figure here because we cannot verify one for this credential from our source data; our salary guide and jobs overview discuss compensation drivers qualitatively, and our ROI analysis walks through whether the investment pays off for different career paths.
Frequently Asked Questions
The American Board of Pediatrics (ABP) issues the certification, and the examination is delivered through Prometric testing centers. Eligibility, scheduling, and fee details should always be confirmed on the ABP's official site.
The exam has approximately 200 multiple-choice questions. The passing standard is a scaled score of 180 on a 1-300 scale, which is not the same as a raw percentage correct.
Asthma is the largest published domain at 9% in the outline effective November 1, 2026. Common Signs and Symptoms and Core Principles of Pulmonary Diagnosis and Monitoring Techniques follow at 8% each.
The official indexed regular fee is $2,992, including a $750 processing component. Fees and registration windows can change, so verify the current amount on the ABP exam dates and fees page before budgeting.
Those rules for the initial examination have not been verified for this guide. Check your ABP confirmation materials and Prometric instructions rather than relying on secondhand reports.
For a broader orientation to this credential and where it fits in the profession, revisit our overview of Pediatric Pulmonology certification, then test your readiness with timed questions at the practice test site.