['Pulmonary rehabilitation (PR) is an established component of COPD management. The lack of exercise performance improvement (EPI) in severely dyspnoeic patients (Medical Research Council [MRC] score 5) has been questioned. The data on the gender impact on EPI after PR remain scarce.', 'The impact of dyspnea severity on PR outcomes was investigated and a question was raised whether severe dyspnea at training onset limits the profit from PR in COPD patients. Additionally, the impact of gender on PR results was analyzed.', '263 consecutive COPD patients underwent outpatient PR. Exercise capacity was assessed by the incremental shuttle walking test (SWT) and dyspnea with the MRC dyspnea score at inclusion (preSWT, preMRC) and at the end of PR (postSWT, postMRC). The data were analyzed in groups according to preMRC. The grade of improvement (deltaSWT, deltaSWT% and deltaMRC) was compared between groups. The influence of gender was analyzed in 138 men and 125 women.', 'A significant absolute increase in SWT and a decrease in MRC score were shown in all groups and for both sexes (p < 0.05) with no significant intergroup differences (p > 0.05). deltaSWT% rose significantly with preMRC score and exceeded the values of a clinically important increase (exception: group 2 with preMRC score 2). No significant differences between men and women were observed (deltaMRC: -0.6 vs. -0.7, deltaSWT: 66.7 vs. 56.0 m, deltaSWT%: 63.7 vs. 58.1%, p > 0.05, respectively).'] Do female and male chronic obstructive pulmonary disease patients with severe dyspnea profit less from pulmonary rehabilitation?