Ralf H. Zwick

Statins differentially regulate vascular endothelial growth factor synthesis in endothelial and vascular smooth muscle cells

OBJECTIVES HMG-CoA reductase inhibitors (statins) can modulate the formation of new blood vessels, but the reports on their contribution to angiogenesis are contradictory. Therefore, we investigated whether the effect of statins is dependent either on the concentration of the drug or on the cell type. METHODS AND RESULTS Under basal conditions human vascular smooth muscle cells (HVSMC) and microvascular endothelial cells (HMEC-1) constitutively generate and release vascular endothelial growth factor (VEGF). In contrast, primary macrovascular endothelial cells (HUVEC) produce minute amounts of VEGF. Different statins (atorvastatin, simvastatin and lovastatin, 1-10 micromol/l) significantly reduced basal and cytokine-, nitric oxide- or lysophosphatidylcholine (LPC)-induced VEGF synthesis in HMEC-1 and HVSMC. Interestingly, at the same concentrations statins upregulated VEGF generation in HUVEC. Furthermore, statins exerted dual, concentration-dependent influence on angiogenic activities of HUVEC as determined by tube formation assay. At low concentrations (0.03-1 micromol/l) the pro-angiogenic activity of statins is prevalent, whereas at higher concentrations statins inhibit angiogenesis, despite increasing VEGF synthesis. CONCLUSION Our data show that statins exert concentration- and cell type-dependent effects on angiogenic activity of endothelial cells and on VEGF synthesis. The data are of relevance for elucidating the differential activity of statins on angiogenesis in cardiovascular diseases and cancer.

Vascular endothelial growth factor (VEGF) plasma concentrations in coronary artery disease

Vascular endothelial growth factor (VEGF) has been associated with atherosclerosis progression and lesion destabilisation. Despite a beneficial effect of local VEGF administration in myocardial and peripheral ischaemia,1 recent evidence suggests a pro-atherosclerotic role of VEGF2 through its ability to enhance plaque inflammatory infiltration and neovascularisation. Despite these results, coming mostly from animal studies, there have been few investigations on the relation between VEGF and human coronary artery disease (CAD). These studies yielded conflicting results regarding VEGF concentrations and gene expression in CAD patients compared to controls.3,4 To elucidate the association of VEGF and CAD further, we performed a prospective study in consecutive patients with chest pain undergoing coronary angiography to compare the coronary status with VEGF plasma concentrations. Written informed consent was obtained from 178 patients. Plasma was collected from a femoral artery access immediately before diagnostic coronary angiography. Exclusion criteria were prior myocardial infarction (< 1 month before inclusion), tumour disease, peripheral arterial occlusive disease, ejection fraction < 30%, acute infections, chronic rheumatoid diseases, and chronic obstructive pulmonary disease. Prior statin use was defined as statin treatment for more than 10 days. VEGF plasma concentrations were determined by enzyme linked immunosorbent assay (ELISA, R&D System, Abingdon, UK). Coronary angiograms were scored visually by a blinded observer: a severity score (0–3) defined the number of vessels with a luminal stenosis ⩾ 50% (for right, left anterior descending, and …

The effect of one year outpatient pulmonary rehabilitation on patients with COPD

SummaryBACKGROUND: The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation. RESULTS: 100 patients (42 female/58 male) with COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), a mean age of 60.5 ± 9.6 years, BMI 25.8 ± 6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P < 0.05), modified Bruce Test (from 13 ± 7 Min to 18 ± 9 Min; P < 0.001), upper limb (from 39.9 ± 3 to 52.9 ± 8 kg; P < 0.001) and lower limb strength increased significantly (from 85.3 ± 45 to 131.5 ± 57 kg; P < 0.001). The maximal inspiratory pressure rose from 81,1 mbar to 108,8 mbar (p < 0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2 ± 3.6 to 26.5 ± 2.8; P < 0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P = 0.006) and the number of hospitalization days (from 27.3 to 3.3, P < 0.001). CONCLUSIONS: One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.ZusammenfassungHINTERGRUND: Ziel unserer Studie war es, den Effekt von einem Jahr ambulanter wohnortnaher Rehabilitation auf funktionelle Parameter sowie auf die Lebensqualität und Exazerbationsrate bei Patienten mit COPD zu untersuchen. METHODIK: Wir inkludierten 100 Patienten in ein multidisziplinäres Rehabilitationsprogramm, welches sowohl Ausdauer-, Kraft- und inspiratorisches Atemmuskeltraining beinhaltet. Wir führten folgende Messungen vor der Rehabilitation sowie nach sechs und 12 Monaten durch: Spiroergometrie, modifizierter Bruce Test, Kraft der Arme und Beine sowie inspiratorische Atemmuskelkraft. Zusätzlich wurde der Saint Georges Respiratory Questionnaire und die Exazerbationstage ein Jahr vor sowie während der Rehabilitation erhoben. ERGEBNISSE: 100 Patienten (42 f/58 m) mit COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), einem mittleren Alter von 60,5 ± 9,6 Jahren, einem BMI von 25,8 ± 6,0 begannen ein pneumologisches Rehabilitationsprogramm über einen Zeitraum von einem Jahr. Die Spiroergometrie (VO2max von 1,1 auf 1,3 l/Min, P < 0.05), der modifizierte Bruce Test (von 13 ± 7 Min auf 18 ± 9 Min; P < 0.001), die Kraft der Arme (von 39,9 ± 3 auf 52,9 ± 8 kg; P < 0.001) und Beine verbesserten sich (von 85,3 ± 45 auf 131,5 ± 57 kg; P < 0.001). Der Maximal inspiratorische Druck stieg von 81,1 auf 108,8 mbar (P < 0.0001). Es kam zu keinen Veränderungen in der FEV1 oder FEV1/FVC, jedoch der Saint Georges Respiratory Questionnaire (Gesamtscore) verbesserte sich von 37,2 ± 3,6 auf 26,5 ± 2,8; P < 0.001. Auch kam es zu einer Reduktion der Exazerbationsraten von 2,8 im Jahr vor der Rehabilitation auf 0,8; P = 0.006) sowie der Hospitalisationstage (von 27,3 auf 3,3, P < 0.001). FOLGERUNGEN: Ein Jahr ambulanter pneumologischer Rehabilitation führt zu einer deutlichen Verbesserung der körperlichen Leistungsfähigkeit und der gesundheitsbezogenen Lebensqualität, weiters können die Anzahl der Exazerbationen sowie die Hospitalisationstage reduziert werden.BACKGROUND The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation. RESULTS 100 patients (42 female/58 male) with COPD (COPD IV-N=36, COPD III-N=42, COPD II-N=22), a mean age of 60.5+/-9.6 years, BMI 25.8+/-6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P<0.05), modified Bruce Test (from 13+/-7 Min to 18+/-9 Min; P<0.001), upper limb (from 39.9+/-3 to 52.9+/-8 kg; P<0.001) and lower limb strength increased significantly (from 85.3+/-45 to 131.5+/-57 kg; P<0.001). The maximal inspiratory pressure rose from 81.1 mbar to 108.8 mbar (p<0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2+/-3.6 to 26.5+/-2.8; P<0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P=0.006) and the number of hospitalization days (from 27.3 to 3.3, P<0.001). CONCLUSIONS One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.

Effects of local gene transfer of VEGF on neointima formation after balloon injury in hypercholesterolemic rabbits.

Enhancement of the generation of nitric oxide (NO) and vascular endothelial growth factor (VEGF) are suggested to prevent restenosis after angioplasty. Accordingly, we tested whether the local delivery of L-arginine (L-Arg), a substrate for NO generation and the VEGF gene, alone or in combination, can influence neointima formation in hypercholesterolemic rabbits. Balloon injury of the iliac arteries was performed in 24 New Zealand White rabbits fed a 1% cholesterol diet for 3 weeks followed by a local infusion of: (1) pSG5VEGF165 plasmid alone (1000 μg); (2) pSG5VEGF165 (1000 μg) with L-Arg (800 mg); (3) L-Arg (800 mg) alone; and (4) L-Arg (800 mg) with naked pSVβ-gal plasmid (1000 μg). The animals were kept on the hypercholesterolemic diets for a further 28 days, when vessels were taken for morphometric analysis and immunocytochemistry. Endogenous rabbit VEGF concentration in the plasma increased significantly at 7 days after injury (17.06 ± 1.57 vs 23.01 ± 1.9 pg/ml; p < 0.02) and remained elevated for up to 28 days (28.46 ± 5.24; p < 0.01). Injured arteries exhibited strong immunocytochemical staining for rabbit VEGF. Rabbits that received a VEGF gene transfer revealed more prominent neointima formation, whereas treatment with L-Arg was associated with significantly less intimal thickness (p < 0.05). Local transfer of the VEGF gene does not inhibit neointima formation in hypercholesterolemic rabbits. Our results suggest that VEGF gene therapy applied locally in atherosclerotic arteries may not be beneficial.

Der Effekt von einem Jahr ambulanter pneumologischer Rehabilitation auf Patienten mit COPD

SummaryBACKGROUND: The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation. RESULTS: 100 patients (42 female/58 male) with COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), a mean age of 60.5 ± 9.6 years, BMI 25.8 ± 6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P < 0.05), modified Bruce Test (from 13 ± 7 Min to 18 ± 9 Min; P < 0.001), upper limb (from 39.9 ± 3 to 52.9 ± 8 kg; P < 0.001) and lower limb strength increased significantly (from 85.3 ± 45 to 131.5 ± 57 kg; P < 0.001). The maximal inspiratory pressure rose from 81,1 mbar to 108,8 mbar (p < 0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2 ± 3.6 to 26.5 ± 2.8; P < 0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P = 0.006) and the number of hospitalization days (from 27.3 to 3.3, P < 0.001). CONCLUSIONS: One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.ZusammenfassungHINTERGRUND: Ziel unserer Studie war es, den Effekt von einem Jahr ambulanter wohnortnaher Rehabilitation auf funktionelle Parameter sowie auf die Lebensqualität und Exazerbationsrate bei Patienten mit COPD zu untersuchen. METHODIK: Wir inkludierten 100 Patienten in ein multidisziplinäres Rehabilitationsprogramm, welches sowohl Ausdauer-, Kraft- und inspiratorisches Atemmuskeltraining beinhaltet. Wir führten folgende Messungen vor der Rehabilitation sowie nach sechs und 12 Monaten durch: Spiroergometrie, modifizierter Bruce Test, Kraft der Arme und Beine sowie inspiratorische Atemmuskelkraft. Zusätzlich wurde der Saint Georges Respiratory Questionnaire und die Exazerbationstage ein Jahr vor sowie während der Rehabilitation erhoben. ERGEBNISSE: 100 Patienten (42 f/58 m) mit COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), einem mittleren Alter von 60,5 ± 9,6 Jahren, einem BMI von 25,8 ± 6,0 begannen ein pneumologisches Rehabilitationsprogramm über einen Zeitraum von einem Jahr. Die Spiroergometrie (VO2max von 1,1 auf 1,3 l/Min, P < 0.05), der modifizierte Bruce Test (von 13 ± 7 Min auf 18 ± 9 Min; P < 0.001), die Kraft der Arme (von 39,9 ± 3 auf 52,9 ± 8 kg; P < 0.001) und Beine verbesserten sich (von 85,3 ± 45 auf 131,5 ± 57 kg; P < 0.001). Der Maximal inspiratorische Druck stieg von 81,1 auf 108,8 mbar (P < 0.0001). Es kam zu keinen Veränderungen in der FEV1 oder FEV1/FVC, jedoch der Saint Georges Respiratory Questionnaire (Gesamtscore) verbesserte sich von 37,2 ± 3,6 auf 26,5 ± 2,8; P < 0.001. Auch kam es zu einer Reduktion der Exazerbationsraten von 2,8 im Jahr vor der Rehabilitation auf 0,8; P = 0.006) sowie der Hospitalisationstage (von 27,3 auf 3,3, P < 0.001). FOLGERUNGEN: Ein Jahr ambulanter pneumologischer Rehabilitation führt zu einer deutlichen Verbesserung der körperlichen Leistungsfähigkeit und der gesundheitsbezogenen Lebensqualität, weiters können die Anzahl der Exazerbationen sowie die Hospitalisationstage reduziert werden.BACKGROUND The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation. RESULTS 100 patients (42 female/58 male) with COPD (COPD IV-N=36, COPD III-N=42, COPD II-N=22), a mean age of 60.5+/-9.6 years, BMI 25.8+/-6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P<0.05), modified Bruce Test (from 13+/-7 Min to 18+/-9 Min; P<0.001), upper limb (from 39.9+/-3 to 52.9+/-8 kg; P<0.001) and lower limb strength increased significantly (from 85.3+/-45 to 131.5+/-57 kg; P<0.001). The maximal inspiratory pressure rose from 81.1 mbar to 108.8 mbar (p<0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2+/-3.6 to 26.5+/-2.8; P<0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P=0.006) and the number of hospitalization days (from 27.3 to 3.3, P<0.001). CONCLUSIONS One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.

Correlation of cardiovascular risk scores with myocardial high-energy phosphate metabolism

The aim of our current work was to prove the association of myocardial high-energy phosphate metabolism measured by MR spectroscopy with validated cardiovascular risk scores, such as the European Systematic COronary Risk Evaluation (SCORE) Project [1], the German PROspective CArdiovascular Munster (PROCAM) Study [2] and the US Framingham Heart and Offspring Studies [3]. We used the ratio of phosphocreatinine (PCr) to β-adenosine-triphosphate (β-ATP) as a surrogate for the energy metabolism of the myocardium [4,5]. PCr-β-ATP ratios are reduced in patients with coronary heart disease [4,5], hypertension [6], and our previous studies suggested cardiovascular risk factors such as hypercholesterolemia [7], diabetes [8] or age [9] to be involved in this process. Therefore we hypothesized a relationship between established primary-event risk scores [1–3] and myocardial high-energy phosphate metabolism. Fasting blood samples of ninety-nine healthy asymptomatic volunteers without history of coronary heart disease were obtained to evaluate cardiovascular risk factors. All of the volunteers underwent cycle ergometry and echocardiography to exclude a latent coronary insufficiency and/or a reduced left ventricular function. Tabulated cardiovascular risk factors and parameters are shown in Table 1. For each patient the cardiovascular risk was assessed by:

Richtlinien für die ambulante pneumologische Rehabilitation in Österreich

ZusammenfassungDie pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie führt zu einer Verbesserung der Leistungsfähigkeit und der Lebensqualität, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.Diese Überarbeitung der Richtlinien der ambulanten pneumologischen Rehabilitation bezieht sich im Wesentlichen auf das 2013 erschienene Statement der American Thoracic Society und der European Respiratory Society.Die Richtlinien präsentieren Qualitätsnormen zur räumlichen und apparativen Infrastruktur, zu Ausbildungserfordernissen des Personals von Zentren und konkrete Richtlinien zur Durchführung einer umfassenden ambulanten pneumologischen Rehabilitation in Österreich.SummaryPulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.

Impact of All-Day Physical Activity on Ventilatory Perfusion Coupling in Patients Undergoing Cardiac Resynchronization Therapy

Objectives: There is still little information about the cardiorespiratory effects of cardiac resynchronization therapy (CRT) in patients undergoing all-day physical activity. This study aimed to assess the effects of CRT on ventilatory perfusion coupling during submaximal exercise. Methods: Metabolic and hemodynamic parameters were obtained during treadmill exercise testing as well as during rest for each single-right (RV), -left (LV) and biventricular (BiV) pacing mode as well as during intrinsic conduction (VVI 30) in 37 patients. Only responders to CRT (>10% increase in cardiac output (CO) during BiV pacing; n = 27) were included into the evaluation. Results: LV and BiV pacing increased systolic (144 ± 25 and 142 ± 28 vs. 118 ± 29 mm Hg, p < 0.05) and mean blood pressure (108 ± 19 and 109 ± 19 vs. 94 ± 25 mm Hg, p < 0.05) as well as CO (7.0 ± 0.6 and 7.2 ± 0.8 vs. 6.0 ± 0.6 l/min, p < 0.05 and p < 0.01) during exercise as compared to VVI 30. Simultaneously, LV and BiV pacing decreased dead space ventilation (18 ± 3 and 17 ± 3 vs. 20 ± 4, p < 0.01) and the ventilatory equivalent for oxygen (31 ± 4 and 31 ± 5 vs. 36 ± 6; p < 0.05) compared to intrinsic conduction. Conclusion: The improvement in ventilatory efficacy during CRT, which is demonstrated by the decrease in the ventilatory equivalent for oxygen, results from an increase in CO and thus from a reduction in the ventilatory perfusion mismatch.

Guidelines for outpatient pulmonary rehabilitation in Austria

ZusammenfassungDie pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie führt zu einer Verbesserung der Leistungsfähigkeit und der Lebensqualität, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.Diese Überarbeitung der Richtlinien der ambulanten pneumologischen Rehabilitation bezieht sich im Wesentlichen auf das 2013 erschienene Statement der American Thoracic Society und der European Respiratory Society.Die Richtlinien präsentieren Qualitätsnormen zur räumlichen und apparativen Infrastruktur, zu Ausbildungserfordernissen des Personals von Zentren und konkrete Richtlinien zur Durchführung einer umfassenden ambulanten pneumologischen Rehabilitation in Österreich.SummaryPulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.

Richtlinien für die ambulante pneumologische Rehabilitation in Österreich@@@Guidelines for outpatient pulmonary rehabilitation in Austria

ZusammenfassungDie pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie führt zu einer Verbesserung der Leistungsfähigkeit und der Lebensqualität, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.Diese Überarbeitung der Richtlinien der ambulanten pneumologischen Rehabilitation bezieht sich im Wesentlichen auf das 2013 erschienene Statement der American Thoracic Society und der European Respiratory Society.Die Richtlinien präsentieren Qualitätsnormen zur räumlichen und apparativen Infrastruktur, zu Ausbildungserfordernissen des Personals von Zentren und konkrete Richtlinien zur Durchführung einer umfassenden ambulanten pneumologischen Rehabilitation in Österreich.SummaryPulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.