נזקי עישון

פרופ' מיכה אדלר

פרופ' יהודה שינפלד

נזקי עישון *

א. הקדמה

ב. תכולת עשן הסיגריות

ג. מחלת לב טרשתית

ד. עישון וסרטן

ט ב ל ה  מ ס ' 1 ; הקשר שבין עישון לבין סוגי סרטן שונים

ה. מחלות ריאה

ו. עישון סביל ו"כפוי" (passive smoking)

ז. פגיעה בעובר

ח. נזקי בריאות נוספים מעישון

ט. סיכום :

הירידה בשיעור המעשנים בעולם

המלצות חינוכיות

ספרות :

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;1958 ,1294 :166 ,men. JAMA 187,783 forty four months of follow-up of Tobacco Smoking, Lyons, France; International Agency for Research (2 Crigui MH, Epidemiology of (3 ;37-47 pp ,(1986) on Cancer, WHO (4 ;1986 ,ISC :57 ,atherosclerosis: an updated overview. Am J Cardiol Department of Health and Human Services.'The health consequences of smoking: cardiovascular disease. A report of the surgeon general. Rockville ,The Pooling Project Group Relationship of blood pressure (5 ;1983 ,Md serum chholesterol, smoking habit, relative weight, and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project. J .Department of Health and Human Services (6 ;1987 ,l20 :l 3 ,Chronic Dis A report of the surgeon general: the health consequences of smoking for Fortmann SP, Haskell WL a Williams (7 ;1980 women. Rockville Md .Plj Changes in palsma HDL cholesterol after changes in cigarette use RR a Hunt Hopkins PN, Williams (8 ;1986 ,706 :124 ,Am J Epidem SC, Magnified risks from cigarette smoking for coronary-prone families in Kalka ~ AJ Leach ,Fiugibbon GM (9 ;1984 ,196 :l4Utah. West J Med, I HP, Atherosclerosis of coronary artery bypass grafts and smoking, Can Coronary heart disease death, non-fatal (0I ;1987 ,45 :136 ,Med Assoc J acute myocardial infarction and other clinical outcomps in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Rosenberg L Kaufman (11 ;1986 ,l :58 ,Research Group. Am J Cardiol after DW, Helmrich SP a Shapiro S, The risk of myocardial infarction ,1511 :319 ,years of age. N Engl J Med 55 quitting smoking in men under Vlietstra KE, Kronmal RA, Oberman A it al, Effect of cigarette (2I ;1985 smoking on survival of ~iatients with angiographically documented coronary ;1986 ,1023 :255 ,artery disease. Report from the CASS registry. JAMA Perkfns J a Dick TBS, Smoking and myocardial infaruion: secondary (3 I Department of Health and (4I ;1985 ,295 :61 ,prevention. Postgrad Med J Human Services. The health consequences of smoking. Cancer: a report of Harris C, Tobacco (5I ;1982 ,the surgeon general. Cancer, Rockville Md ;1986 ,607 :105 ,smoke and lung disease: who is susceptiblel Ann Int Med and per 1947-80 ,Kristein MM, Japanese lung cancer mortality rates (6I ,140 :15 ,capita cigarette consumption in Japan )letter(. Internat J Epidem .Canada Wigle DT, Mao Y, Semencin R & al, Cancer patterns in (7I ;1986 IARC :WHO- Tobacco Smoking (8I ;1986 ,231 :134 ,Canad Med Assoc J ,Vecchia C La (19 ;1986 ,421 :38 ,Geneva, Geneva 1985 working group Decarli A a Tognoni Y, Cigarette smoking and the risk of ,Franceschi S

Cole ~ Austin H (20 ;1986 ,22 :123 ,cervical neoplasm. Am J Epidemiol l( The2 ;1986 ,417 :39 ,P, Cigarette smoking and leukemia. J Chron Dis health consequences of smoking. Chronic obstructive airways disease: a report of the Surgeon General U.S. Department of Health and Human R, Mortality Peto Doll R ai (22 ;1984 ,Services, Public Health Service years' observation on male British doctors. Br 20 :in relation to smoking Sterling TD, Dimieh H a Kobayashi D, Indoor (23 ;1976 ,1525 :2 ,Med J byproduct levels of tobacco smoke: a critical review of the literature. J Speer F, Tobacco and the (24 ;1982 ,250 :23 ,Air Pollut Control Assoc ,443 :16 ,nonsmoker: a study of subjective symptoms. Arch Environ Health Vial WC, South Western Internal Medicine Conference: cigarette (25 ;1968 Hirayama (26 ;1986 ,130 :291 ,smoking and lung disease. Amer J Med Sci T, Nonsmoking wives of heavy smokers have a higher risk of lung cancer: a 0 GarJinkel L Auerbach (27 ;1981 ,183 :282 ,study from Japan. Br Med J .Joubert L Involuntary smoking and lung cancer: A case-control study a Chariton Ai Children's coughs related (28 ;1985 ,463 :75 ,J Natl Cancer Inst Ijard R, Perdrizet S (29 ;1984 ,1647 :288 ,to parental smoking. Br Med J .a Reinert P, Wheezey bronchitis in infants and parents' smoking habits Tashkin DP, Clark VA, Simmons M Ba al, The (30 ;1982 ,334 :1 ,Lancet .UCLA population studies of chronic obstructive respiratory disease VII Relationship between parenlaI smoking and children's lung function. Am Morrison BJ, The effect AB a Murray (31 ;1984 ,891 :129 ,Rev Respir Dis of cigarette smoke from the mother on bronchial responsiveness and severity ;1986 ,575 :77 ,of symptoms in children with asthma. J Allerg Clin Immunol Wienser LA, Relationship of passive cigarette-smoking AB a Bergman (32 Smoking (33 ;1976 ,665 :58 ,to sudden infant death syndrome. Pediatrics ,and Health: a report of the Surgeon General. U.S. Department of Health Visujevac V a (34 ;1979 ,Education and Welfare, Public Health Service Mikov M, Smoking and carboxyhemoglobin concentrations in mothers Himmelberger (35 ;1986 ,75] :5 ,and their newborn infants. Hum Toxicol DU, Brown BW a Cohen Eff, Cigarette smoking during pregnancy and the occurrence of spontaneous abortion and congenital abnormality. Am ,Kulikauskas V, Blaustein D a Ablin RJ (36 ;1978 ,470 :108 ,J Epidemiol ,526 :44 ,Cigarette smoking and its possible effects on sperm. Fert Ster Evanw JIJ, Fletcher J, Torrance M ~ ilargreave TB, Sperm (37 ;1985 Bornman (38 li98I ,527 :1 ,abnormalities and cigarette smoking. Lancet B~S a Du Plessis DJ, Smoking and vascular impotence: a reason for Model D, Smokers' face: an (39 ;1986 ,329 :70 ,concern. S Afr Med J 'Smokers ,S~er A (40 ;1985 ,1760 :291 ,Br Med J 1underrated clinical sign

McCarthy (41 ;1986 ,1496 :146 ,the smokers? Arch Int Med faces: who are (42 ;1984 ,726 :I31 ,DM, Smoking and ulcers time to quit. N Engl J Med S, Graham DY, Belsito A & al, Cimetidine, cigarette smoking and Sontag Daling (43 ;1984 ,689 :311 ,recurrences of duodenal ulcer. N Engl J med lR Sherman Kl ~ Weiss NS, Risk factors for condyloma acuminatum in ,Danies R ~ Scha S (44 ;1986 ,16 :13 ,women. J Amer Vener Dis Assoc Ismail AI, Burt BA (45 ;1985 ,107 :32 ,Osteoporosis. Amer Fam Physic a Bklund SA, Epidemiologic patterns of smoking and periodontal disease iform lW (46 ;1983 ,617 :106 ,in the United States. J Amer Dent Assoc .a Kessler LG, Falling rates of lung cancer in men in the United States Chapman S, Stop smoking clinics: a case for their (47 ;1986 ,425 :Lancet, I 1985. ,918 :abandonment. Lancet, l

 

 

* מאז פורסמו מעל דפי אסיא לז (י, א, כסלו תשמ"ד) הסקירות העדכניות של ד"ר אפרים מלצר, על השפעת העישון על מערכת הלב, כלי-הדם והנשימה (ספר אסיא ה, עמ' 233-222), ושל ד"ר בת שבע הרשקוביץ עם פרופ' רפאל קטן, על הקשר בין העישון למחלות ממאירות (ספר אסיא ה, עמ' 237-234) – הוסיפו להצטבר קטעי מידע חדשים אודות נזקי העישון האקטיבי והפאסיבי. לנתונים אלו משמעות הלכתית ברורה וחובה להביאם לידיעת מורי ההוראה. לשם כך מובאת כאן סקירה עדכנית ומקיפה על נזקי העישון, כבסיס להמשך הדיון ההלכתי בנושא הנוגע לחיי האדם ובריאותו.

הסקירה שלפנינו פורסמה ב"הרפואה" (קטז:ה, 1989) והיא מתפרסמת גם ב"אסיא" באדיבותו הרבה של עורך "הרפואה" פרופ' י. רותם.

על השפעת פרסום המידע הרפואי וההלכתי ב"אסיא" על העישון בבתי המדרש ובאולמות הלימוד בישיבות – ראה ספר אסיא ה, עמ' 262-261, ובעקבות ישיבת פוניבז' בבני ברק, הצטרפו ישיבות נוספות לאיסור העישון בהיכל, ביניהם ישיבת מיר בירושלים ועוד. וראה מש"כ הגרש"ז אויערבאך שליט"א, להלן עמ' 366. – העורך.

** ראה ספר אסיא ה, עמ' 258.  -העורך