Pulmonary rehabilitation exercise program for high-risk thoracic surgical patients.

Preoperative assessment of the patient with moderate to severe COPD continues to be a difficult task. Pulmonary function tests cannot be the only deciding factor. Exercise testing is supported in the literature to improve the sensitivity and specificity in predicting perioperative morbidity and mortality rates. The presence of comorbid disease, especially COPD, increases the chances of postoperative pulmonary complications. Pulmonary rehabilitation in the nonsurgical COPD patient has been proven to be beneficial in improved exercise capacity and quality of life. The question which remains to be answered is whether a short-term, intense, and focused preoperative program in surgical candidates with resectable NSCLC and preexisting pulmonary dysfunction can influence outcome.