Introduction: Pulmonary rehabilitation has benefits in optimizing functional capacity and reducing perioperative risk in patients with chronic respiratory disease undergoing surgery. Clinical Case Description: A 68-year-old female, active smoker, with GOLD 2E COPD, and a solid pulmonary nodule in the left lower lobe (LLL). After two bronchofibroscopies with negative biopsies, surgical resection for diagnostic purposes was discussed. The patient was referred to a pulmonary rehabilitation consultation for surgical risk assessment. She presented with mMRC dyspnea 1, CAT of 9, no limitation in activities of daily living, BMI 22 kg/m2. Spirometry showed obstructive ventilatory impairment with mildly reduced DLCO (post-bronchodilator FEV1 72%; DLCO 59%). Hemoglobin levels and echocardiography were normal. Cardiopulmonary exercise testing (CPET) indicated high surgical risk according to the 2025 ERS/ESTS guidelines, with a peak VO2 of 19.2 mL/kg/min and a VE/VCO2 slope of 42, despite preserved exercise capacity. In this context, pulmonary rehabilitation was identified as a potentially modifiable factor to improve physiological reserve. The patient was referred to a two-week pulmonary rehabilitation program, including smoking cessation support, supervised aerobic exercise with ventilatory control training targeting dynamic hyperinflation, peripheral muscle strengthening with ventilatory strategies to facilitate lung expansion, and energy conservation techniques during more demanding exercise tasks. After one month, repeat CPET showed a 7.8% increase in peak VO2 (20.7 mL/kg/min). Although ventilatory inefficiency persisted, the functional gains achieved through rehabilitation supported proceeding with surgery in the context of clinical necessity and in alignment with the 2009 ERS/ESTS criteria. A wedge resection of the LLL by VATS was performed, without complications, and the patient was discharged after 48 hours. Conclusions: This case highlights the role of preoperative pulmonary rehabilitation in improving functional optimization and postoperative outcome in COPD patients. Even in the presence of persistent high-risk criteria, pulmonary rehabilitation contributed to improved exercise capacity and supported a favorable surgical and postoperative outcome.
Couto et al. (Wed,) studied this question.