A quarter to a third of all smokers suffer from chronic obstructive pulmonary disease – also known as emphysema – which is an incurable lung disease causing restricted airflow and breathing problems that can make sufferers feel like they are trying to breathe underwater.

But few COPD patients have ever heard of it, according to Prof. Zvi Fridlender, founding director and senior physician of the internal medicine department at the Lung Institute of Hadassah-University Medical Center in Jerusalem’s Ein Kerem. He is also chairman of the Israel Association of Pulmonology.

COPD is the fourth leading cause of death worldwide, responsible for almost four million annually, or 5% of the total. Tobacco smoking and second- and third-hand smoking (exposure to other’s smoke or toxins on rugs, curtains, and furniture) accounts for over 70% of COPD cases in high-income countries, with symptoms including coughing, sometimes with phlegm, difficulty breathing, wheezing, and tiredness.

Many sufferers can’t even walk a hundred meters and have to be constantly attached to oxygen tanks. Patients are at higher risk of other health problems such as lung cancer, lung infections, heart problems, weak muscles, brittle bones, and depression and anxiety.

“We have plenty of laws. Anyone who is caught smoking in public places should be getting a NIS 1,000 fine, but they aren’t caught,” Fridlender told The Jerusalem Post.

PROF. NEVILLE BERKMAN (credit: HADASSAH MEDICAL ORGANIZATION)
PROF. NEVILLE BERKMAN (credit: HADASSAH MEDICAL ORGANIZATION)

Smoking rates increased in Israel since October 7, 2023

“The laws aren’t enforced by the authorities – the police and the municipalities. There are few effective information campaigns, and taxes on tobacco – cigarettes, rolling tobacco, and electronic cigarettes – must be very high to deter young smokers,” he said. “While in other countries like the UK, once a law is passed, it is usually honored. Here it is more like a recommendation that is very often ignored.”

ANTI-SMOKING activists are furious at Sharon Kedmi, chairman of the Israel Aviation Authority, for canceling the prohibition of smoking rooms in the airports. This violated the authority’s commitment to a court in a class action suit filed by Amos Hausner, lead lawyer for the Israel Association for the Prevention of Smoking.

The longtime anti-tobacco attorney is currently demanding that the courts prohibit smoking on balconies of apartment buildings or other locations that exposes non-smokers to their neighbors’ smoke. In California, 101 local authorities have already completely banned smoking in multi-unit homes, and since 2018, it has been totally prohibited in all federal multi-unit buildings.

Smoking rates are growing among young Israelis, said Fridlender, an internationally renowned researcher of neutrophil white blood cells of the immune system, especially their role in lung cancer. He has also been a member of the international body that sets guidelines for the treatment of COPD.

“While smoking rates have significantly declined in the US, Europe, and elsewhere, it has increased in Israel since the Iron Swords War began on October 7, 2023,” he said.

Prof. Neville Berkman, who heads the lung institute at Hadassah, added that it’s not only smokers who are at health risk.

“People who themselves don’t light up think they’re safe, but many of them are exposed to lethal tobacco smoke by inhaling it from smokers in the family, at work, and in public spaces,” he said.

Electronic cigarettes (e-cigs) also cause lung cancer, which is the main cause of death from cancers in Israel, Berkman said, adding that people who start smoking them, especially young people, tend to move on to smoking regular cigarettes.

“There is behavioral addiction, not just a physical one. They are used to having something in their mouths. Younger smokers may do it to show off, to show they are grown up,” he said. 

“Smoking should be recognized by society as an unacceptable practice. Religious Jews who don’t smoke on Shabbat (although some use nicotine patches then) prove that it’s also behavioral, because they can stop one day a week,” the lung institute’s head said. “The rabbis must tell them that smoking – causing harm to your own body and the health of others – is forbidden according to Jewish law.”

SMOKERS WHO cough or have other symptoms can ask for a low-radiation-dose CT scan every year, said Berkman.“It’s in the basket of health services provided by the public health funds, which recognize the fact that treating their members for lung cancer and COPD is more expensive.”

The last decade has seen significant improvement in treatment of lung cancer, he continued. “There are biological therapies – pills and injections – that increase survival rates, but these are not pleasant to undergo, as they have side effects,” he stressed.

Biological therapies for lung cancer, also known as targeted therapies and immunotherapies, are treatments that use substances produced by living organisms or are designed to target and destroy cancer cells. Immunotherapy works by boosting the immune system’s ability to recognize and destroy cancer cells, either by directly attacking them or by helping other immune cells do so. Drugs that alter the immune system can also be effective.

These therapies aim to enhance the body’s natural defenses against cancer, block cancer growth, or prevent the spread of cancer. “The earlier the stage of the disease, the better. If the cancer is advanced, radiation therapy, chemotherapy, and other treatments are available, but if they also have COPD, most can’t undergo surgery to remove the tumor,” Berkman said.

The most important thing is prevention – by not starting to smoke in the first place, he said, adding that if they do start, there are free cessation courses from their health fund, behavioral therapy, phone apps, and drugs that reduce the urge to smoke – “and the Health Ministry offers a telephone support system.”

THE 2024 report on smoking issued by the Health Ministry found that one in five adult Israelis smokes, and the Israeli rate is significantly higher than the global average, and said that E-cigs are a leading smoking product among youth. Quitting smoking here is occurring at a rate 50% lower than the OECD average. 

Although the ministry has finally approved regulations for putting graphic health warnings on smoking products and barring tax-free status for tobacco at airports – two decades after Israel committed itself to doing so under the World Health Organization’s Framework Convention on Tobacco Control – it is giving companies a year or two to implement them.

An in-depth survey conducted with youth for the ministry shows that the electronic cigarette is the first product tried by about 53% of all those experimenting with products. It was also found that very high numbers of youth use smoking products with added flavors – 88% for hookahs, 82% for electronic cigarettes, and 45% for regular cigarettes and rolling tobacco. 

The first survey of its kind, conducted among young people in haredi (ultra-Orthodox) society, shows high rates of experimenting with smoking products: 54% in their yeshivot for teens and 80% among haredi teenagers who drop out of religious studies.

The latest Smoking Report shows that during the past year, 82 local and regional authorities and councils also reported on activity under the Smoking Prevention Law in Public Places – but more than 65% of local authorities don’t report to the ministry or enforce the law, and no government action is taking against them.