上本町わたなべクリニックの
禁煙外来　⇒　禁煙外来　メディア出演　トップページ


毎年5月31日は、世界禁煙デーです。
この機会に禁煙にチャレンジしましょう。



タバコの害情報
タバコの害の日本人大規模コホート研究

原著論文の タイトル	著者・所属	掲載論文
①Population Attributable Fraction of Mortality Associated with Tobacco Smoking in Japan: A Pooled Analysis of Three Large-scale Cohort Studies	KatanodaKota MarugameTomomi, SaikaKumiko, SatohHiroshi, TajimaKazuo, SuzukiTakaichiro, TamakoshiAkiko, TsuganeShoichiro, SobueTomotaka Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center	Journal of Epidemiology(0917-5040) 18巻6号 Page251-264(2008.11)
②Reduced life expectancy due to smoking in large-scale cohort studies in Japan.	Ozasa K, Katanoda K, Tamakoshi A, Sato H, Tajima K, Suzuki T, Tsugane S, Sobue T. Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566	J Epidemiol. 2008;18(3):111-8. Epub 2008 May 14.
③Decrease in risk of lung cancer death in Japanese men after smoking cessation by age at quitting: pooled analysis of three large-scale cohort studies.	Wakai K, Marugame T, Kuriyama S, Sobue T, Tamakoshi A, Satoh H, Tajima K, Suzuki T, Tsugane S. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.	Cancer Sci. 2007 Apr;98(4):584-9.
①の論文の要旨 Background: Quantitative measures of the burden of tobacco smoking in Asian countries are limited. We estimated the population attributable fraction (PAF) of mortality associated with smoking in Japan, using pooled data from three large-scale cohort studies.Methods: In total, 296,836 participants (140,026 males and 156,810 females) aged 40-79 years underwent baseline surveys during the 1980s and early 1990s. The average follow-up period was 9.6 years. PAFs for all-cause mortality and individual tobacco-related diseases were estimated from smoking prevalence and relative risks.Results: The prevalence of current and former smokers was 54.4% and 25.1% for males, and 8.1% and 2.4% for females. The PAF of all-cause mortality was 27.8% [95% confidence interval (CI): 25.2-30.4] for males and 6.7% (95% CI: 5.9-7.5) for females. The PAF of all-cause mortality calculated by summing the disease-specific PAFs was 19.1% (95% CI: 16.0-22.2) for males and 3.6% (95% CI: 3.0-4.2) for females. The estimated number of deaths attributable to smoking in Japan in 2005 was 163,000 for males and 33,000 for females based on the former set of PAFs, and 112,000 for males and 19,000 for females based on the latter set. The leading causes of smoking-attributable deaths were cancer (61% for males and 31% for females), ischemic heart diseases and stroke (23% for males and 51% for females), and chronic obstructive pulmonary diseases and pneumonia (11% for males and 13% for females).Conclusion: The health burden due to smoking remains heavy among Japanese males. Considering the high prevalence of male current smokers and increasing prevalence of young female current smokers, effective tobacco controls and quantitative assessments of the health burden of smoking need to be continuously implemented in Japan.
②の論文の要旨 Background: To show the reduction in life expectancy due to smoking and the recovery of normal life expectancy by smoking cessation is useful for tobacco control health policy. Methods: This study included 140,026 males and 156,810 females aged 40-79 years, who were participants of large-scale cohort studies in Japan (Japan Health Center-based Prospective Study [JPHC]-I, JPHC-II, Three-Prefecture Study, and Japan Collaborative Cohort [JACC] Study), which commenced around 1990. The mean follow-up period (±standard deviation) was 9.6 ± 2.3 years, during which 16,282 men and 9,418 women died. For persons aged 40-79 years grouped according to each defined smoking status in the baseline questionnaire, sex- and age-specific death rates at attained ages were calculated. The age-specific death rate was calculated by dividing the number of persons who died at the age by the number of persons who were followed-up at the attained age. From these death rates, current life tables were constructed according to the smoking status, and survival curves were plotted. Results: The life expectancy of male smokers, ex-smokers, and never-smokers at age 40 years was 38.5, 40.8, and 42.4 years respectively. In women, the corresponding life expectancies were 42.4, 42.1, and 46.1 years. In both sexes, the age by which half of the current smokers had died was approximately 4 years younger than that for never-smokers. The life expectancies of male ex-smokers who quit smoking before ages 40, 50, 60, and 70 years were 4.8, 3.7, 1.6, and 0.5 years longer than those of smokers, respectively. Conclusion: Smoking considerably reduced the life expectancy, and earlier smoking cessation resulted in a better survival than that seen with continued smoking.
③の論文の要旨 To evaluate the impact of smoking cessation on individuals and populations, we examined the decrease in risk of lung cancer death in male ex-smokers by age at quitting by pooling the data from three large-scale cohort studies in Japan. For simplicity, subjects were limited to male never smokers and former or current smokers who started smoking at ages 18-22 years, and 110,002 men aged 40-79 years at baseline were included. During the mean follow-up of 8.5 years, 968 men died from lung cancer. The mortality rate ratio compared to current smokers decreased with increasing attained age in men who stopped smoking before age 70 years. Among men who quit in their fifties, the cohort-adjusted mortality rate ratios (95% confidence interval) were 0.57 (0.40-0.82), 0.44 (0.29-0.66) and 0.36 (0.13-1.00) at attained ages 60-69, 70-79 and 80-89 years, respectively. The corresponding figures for those who quit in their sixties were 0.81 (0.44-1.48), 0.60 (0.43-0.82) and 0.43 (0.21-0.86). Overall, the mortality rate ratio for current smokers, relative to non-smokers, was 4.71 (95% confidence interval 3.76-5.89) and those for ex-smokers who had quit smoking 0-4, 5-9, 10-14, 15-19, 20-24 and >or=25 years before were 3.99 (2.97-5.35), 2.55 (1.80-3.62), 1.87 (1.23-2.85), 1.21 (0.66-2.22), 0.76 (0.33-1.75) and 0.67 (0.34-1.32), respectively. Although earlier cessation of smoking generally resulted in a lower rate of lung cancer mortality in each group of attained age, the absolute mortality rate decreased appreciably after stopping smoking even in men who quit at ages 60-69 years.

タバコの害の疫学調査

調査機関	調査年度	喫煙者の肺がんの率
国立がん研究センター	1966～82年	男性が4.5倍、女性が2.3倍
アメリカがん協会	1982～86年	男性は22.4倍、女性は11.9倍

ニコチンについて

皆さんご存じのニコチンですが、実際どれほど危険であるかを示してみました。

◎ニコチン：非常に猛毒（もうどく）
◎致死量は体重1kgあたり1mg以下です。
◎体重40kgの場合、30～40mg程度で死亡します。
◎原料のたばこ葉も食べると死にます。
◎脳に影響を与え、タバコがクセになるようになる。
（参考例：青酸カリの致死量は体重1kgあたり2~3mg）
◎ニコチンはタバコを吸って約4～10秒で脳に達し、影響を与えます。


タバコを吸うと煙の中のニコチンが肺に入り、それが毛細血管から吸収されて全身に運ばれます。その速さは、わずか7秒で脳に達するほどです。ニコチンは自律神経を刺激して血管を収縮させるので、その結果皮膚の温度が下がるほか、せきやたん、動悸、息切れ、頭痛、食欲不振、吐き気や嘔吐を引き起こします。

タバコについての一般的な知識
～上本町わたなべクリニック院長メディア出演要旨から～

11月23日（日）
禁煙（著作権：医学博士渡邊章範院長：無断転載禁止）

AN：今日も上本町わたなべクリニックの渡邊章範（たかのり）先生にお越しいただいております。今日は、禁煙外来についてお伺いしたいと思います。早速ですが、何故、タバコは一度吸い出すと、なかなかやめられないのでしょうか？

DR：タバコの中のニコチンの2つの作用が関係しています。一つ目は、幸せな気分にさせるドーパミン作用、二つ目は、不安な気持ちを落ち着かせるセロトニン作用です。

AN：なるほど、幸せな気分にさせるドーパミン作用で、ニコチン依存から抜け出せなくなるということですね。そして、セロトニン作用でたばこを吸うと落ち着くのですね。たばこを吸うと肺がんになりやすいって言うのは知っていますが、他にどんな怖いことがあるのですか?

DR：肺がんだけでなく、胃がんや膀胱がんなども引き起こします。また、高血圧や動脈硬化の原因にもなります。また、過酸化水素によって、肺の組織が破壊されます。タバコの中の有害物質は200を越えるといわれています。

AN：やはりタバコはやめたほうがいいですね。禁煙外来ではどのような治療をされるのでしょうか？薬の処方もあるのでしょうか？

DR：現在、禁煙治療の方法は、3つあります。ニコチンガム、ニコチンパッチ、そして今年5月に発売された飲む禁煙薬です。ニコチンガムはスウェーデン海軍の要請により開発されました。潜水艦の乗務員に禁煙させる必要があったからです。次に、ニコチンそのものを24時間かけて皮膚からゆっくりと吸収させるニコチンパッチが開発されました。

AN：どちらもタバコの換わりにニコチンを少しずつ体に入れるのですね。飲む禁煙薬は、ニコチンを飲むのでしょうか?

DR：ニコチンは、猛毒ですから飲んだら死んでしまいます。飲む禁煙薬、チャンピックスは、ニコチンそのものではなく、ニコチンに似た物質からできています。これにより、たばこを吸っても爽快感が得られなくなります。当院で治療している患者さんの話では、飲みだして6日目ぐらいからタバコの味が薄く感じたり、まずく感じたりするようです。ニコチンパッチで禁煙できなかった人も禁煙に成功しています。

AN：最近では、禁煙治療で保険が使えると聞いたのですが。

DR：禁煙治療の実績のある医師と看護師がいるなど条件が厳しく、大阪市内でもまだまだ、数が少ないようです。そういえば、大事なタバコの副作用を忘れていました。

AN：え、なんですか？

DR：タバコ20本吸うと、体の中のビタミンCの三分の一が消費されます。この結果、しわやたるみの原因になるんです。

AN：タバコは、女性の敵ですね。たばこを吸っている友達にも禁煙外来を勧めてみます。

上本町わたなべクリニック院長メディア出演については⇒　メディア出演
上本町わたなべクリニックの禁煙外来⇒　禁煙外来　トップページ

予約不要です。診察時間内にお越しください。

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