..

2. 2

3. 3
Can I use an asthma inhaler
during Ramadan?

4. 4

5. Airway
inflammation
Airflow
obstruction
Bronchial
hyperresponsiveness
Symptoms
Asthma Pathophysiology
The tip of the iceberg

7. 7
Smooth
muscle
dysfunction
Airway
inflammation/
remodelling
r
• Inflammatory cell infiltration/
activation
• Mucosal oedema
• Cellular proliferation
• Epithelial damage
• Basement-membrane thickening
• Bronchoconstriction
• Bronchial hyper-reactivity
• Hyperplasia
• Inflammatory-mediator
release
Symptomsexacerbations
Asthma is a two component disease

8. 8

9. 9

10. 10
Inhaled therapy constitutes the cornerstone
of asthma treatment

11. 11

12. 12
Controllers
 Inhaled corticosteroids
 Inhaled long-acting b2-
agonists
 Oral anti-leukotrienes
 Oral theophyllines
Relievers
 Inhaled fast-acting b2-agonists
Medications for Asthma Management

13. Beclomethasone
Budesonide
Fluticasone
Inhaled corticosteroids

14. 14

15. 15

16. 16

17. 17

18. 18
Although Islamic rules state that people with long-
term conditions such as asthma are permitted not to
fast, some Muslims with asthma still choose to fast
during Ramadan and many may consider using an
inhaler to be breaking their fast.

19. 19
In a Muslim population, the patients with asthma and
COPD do not feel their diseases to be an inhibitory
factor for fasting during Ramadan
In one survey, only 42% of the patients were found to
adhere to their usual treatment, while the remaining
patients either stopped or changed their drug intake
pattern while fasting during Ramadan.
.

20. 20
A project was undertaken, at Barts Health, to determine
medication usage in theTower Hamlets Muslim
population during Ramadan.
The results were quite alarming:
It was found that 23% of patients did not take their
medication at all during the holy month, and a further
48% doubled their evening dose to compensate for
medicines normally taken twice a day.

21. 21
Doubling the dose of twice-daily medication or omitting
a dose altogether could in some cases cause severe
adverse effects and is an important point to consider
when prescribing or counselling this group of patients.

22. 22
if when you're fasting , you choose not to take your
medicines exactly as prescribed (for example, if you
stop using your inhaler(s) because you believe that
using an inhaler would break your fast or you use
them at different times to the prescribed times), this
can cause your symptoms to get worse.

23. 23
In fact, stopping your medicines can cause your asthma
symptoms to return and increase your risk of a life-
threatening asthma attack.
If you are not allowed to drink liquids during your fast,
be aware that dehydration can dry the airways and
may make your asthma worse.

24. 24
Can I use an asthma inhaler
during Ramadan?

25. 25
Muslim experts have differing opinions on this issue.
Some say that using an asthma inhaler isn’t the same as
eating or drinking, and is therefore permissible during
fasting.
According to this view, asthmatics may fast and use
their inhalers whenever required during fasting.

26. 26
However, other scholars say that the inhaler provides
small amounts of liquid medicine to the lungs, so it
breaks the fast.
They say that people with poor control of their
asthma must not fast until good control is achieved.
Some people with asthma may opt for longer-acting
inhalers so that they can fast.

27. 27
If asthma medication is required as treatment for a short
illness, you can compensate for missed fasts by fasting on
other days when you are well.
Those who are unable to carry out the missed fasts
later, due to the long-term use of medication, should do
fidyah.
Fidyah is a method of compensation for a missed act of
worship, such as paying for someone to be fed

28. 28

29. 29

30. 30

31. 31

32. 32
‫تعاطي‬ ‫ذا‬‫ا‬ ‫الصامئ‬ ‫يفطر‬ ‫هل‬‫خباخ‬‫بو‬‫ر‬‫ال‬‫يف‬ ‫ال‬ ‫و‬‫أ‬‫طر؟‬
•‫ل‬‫و‬‫ق‬ ‫عىل‬ ‫ةل‬‫سأ‬‫مل‬‫ا‬ ‫هذه‬ ‫ا‬‫و‬‫ث‬‫حب‬ ‫اذلين‬ ‫العمل‬ ‫هل‬‫أ‬ ‫من‬ ‫املعارصون‬ ‫اختلف‬‫ني‬:
•‫ت‬ ‫ند‬‫ع‬ ‫يفطر‬ ‫ال‬ ‫الصامئ‬ ‫ن‬‫أ‬ ‫ىل‬‫ا‬ ‫ين‬‫رص‬‫املعا‬ ‫من‬ ‫العمل‬ ‫هل‬‫أ‬ ‫كرث‬‫أ‬ ‫فذهب‬‫لهذه‬ ‫يه‬‫ط‬‫عا‬
‫املادة‬‫صامئ‬ ‫وهو‬ ‫الغاز‬ ‫و‬‫أ‬‫الع‬ ‫بد‬‫ع‬ ‫يخ‬‫ش‬‫ل‬‫ا‬ ‫شاخي‬‫مل‬‫ا‬ ‫القول‬ ‫هذا‬ ‫قال‬ ‫ممن‬‫و‬‫بن‬ ‫يز‬‫ز‬
،‫ابز‬،‫ميني‬‫ث‬‫لع‬‫ا‬ ‫صاحل‬ ‫بن‬ ‫محمد‬ ‫يخ‬‫ش‬‫ل‬‫ا‬‫و‬‫جب‬ ‫بن‬ ‫هللا‬ ‫بد‬‫ع‬ ‫يخ‬‫ش‬‫ل‬‫ا‬‫و‬‫ين‬‫يخ‬‫ش‬‫ل‬‫ا‬‫و‬
‫الصديق‬ ‫محمد‬‫ير‬‫رض‬‫ال‬‫سع‬‫ل‬‫ا‬ ‫ية‬‫ب‬‫ر‬‫الع‬ ‫اململكة‬ ‫يف‬ ‫فتاء‬‫لل‬ ‫مئة‬‫ا‬‫ادل‬ ‫نة‬‫للج‬‫ا‬‫و‬‫ودية‬

33. Children’s Healthcare of Atlanta

34. 34
‫ال‬‫ؤ‬‫س‬‫ل‬‫ا‬ ‫عىل‬ ‫اب‬‫و‬‫اجل‬:‫ا‬ ‫يصل‬ ‫وال‬ ‫تبخر‬‫ي‬ ‫نه‬‫و‬‫لك‬ ‫تعمهل‬‫س‬‫ت‬ ‫اذلي‬ ‫بخاخ‬‫ل‬‫ا‬ ‫هذا‬ ‫ن‬‫أ‬‫ىل‬
‫نقول‬ ‫نئذ‬‫ي‬‫حف‬ ‫املعدة‬:‫تف‬ ‫وال‬ ‫صامئ‬ ‫نت‬‫أ‬‫و‬ ‫بخاخ‬‫ل‬‫ا‬ ‫هذا‬ ‫تعمل‬‫س‬‫ت‬ ‫ن‬‫أ‬ ‫س‬‫بأ‬ ‫ال‬‫طر‬
‫تب‬‫ي‬‫و‬ ‫تطاير‬‫ي‬ ‫يشء‬ ‫نه‬‫ل‬ ‫اء‬‫ز‬‫ج‬‫أ‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫منه‬ ‫يدخل‬ ‫ال‬ ‫نا‬‫قل‬ ‫كام‬ ‫نه‬‫ل‬ ‫بذكل‬‫خر‬
‫يزول‬‫و‬‫و‬‫فيج‬ ‫الفطر‬ ‫يوجب‬ ‫مما‬ ‫هذا‬ ‫ن‬‫ا‬ ‫نقول‬ ‫حىت‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫جرم‬ ‫منه‬ ‫يصل‬ ‫ال‬‫وز‬
‫الصوم‬ ‫بطل‬‫ي‬ ‫وال‬ ‫صامئ‬ ‫نت‬‫أ‬‫و‬ ‫تعمهل‬‫س‬‫ت‬ ‫ن‬‫أ‬ ‫كل‬‫بذكل‬.
[‫هللا‬ ‫رمحه‬ ‫ميني‬‫ث‬‫ع‬ ‫ابن‬ ‫يخ‬‫ش‬‫ل‬‫ا‬-‫الفتاوى‬1/500]
‫س‬:‫يفطر‬ ‫هل‬ ‫للصامئ‬ ‫نفس‬‫ل‬‫ا‬ ‫يق‬‫ض‬ ‫خباخ‬ ‫تعامل‬‫س‬‫ا‬‫؟‬

35. 35
‫ا‬‫و‬‫تدل‬‫س‬‫ا‬‫و‬ ‫الصوم‬ ‫سد‬‫يف‬ ‫وال‬ ‫يفطر‬ ‫ال‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬:
‫أ‬-‫سيب‬ ‫متضمض‬ ‫ذا‬‫ا‬‫و‬ ، ‫جامع‬‫ابال‬ ‫وهذا‬ ، ‫شق‬‫تن‬‫س‬‫ي‬‫و‬ ‫متضمض‬‫ي‬ ‫ن‬‫أ‬ ‫هل‬ ‫الصامئ‬ ‫ن‬‫بأ‬‫قى‬
‫ىل‬‫ا‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫من‬ ‫ادلاخل‬‫و‬ ‫؛‬ ‫املعدة‬ ‫يدخل‬‫س‬ ‫يق‬‫ر‬‫ال‬ ‫بلع‬ ‫مع‬ ‫املاء‬ ‫ثر‬‫أ‬ ‫من‬ ‫يشء‬
‫هذا‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫مث‬ ‫املريء‬‫جدا‬ ‫يل‬‫قل‬‫املض‬ ‫بعد‬ ‫بقي‬‫ت‬‫مل‬‫ا‬ ‫املاء‬ ‫عىل‬ ‫فيقاس‬ ، َ‫مضة‬.
‫ب‬-‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫من‬ ‫املعدة‬ ‫عىل‬ ‫يشء‬ ‫دخول‬ ‫ن‬‫أ‬‫يضا‬‫أ‬‫و‬‫يا‬‫قطع‬ َ‫ا‬‫ر‬‫م‬‫أ‬ ‫ليس‬َ‫؛‬
‫شك‬‫ل‬‫اب‬ ‫يزول‬ ‫ال‬ ‫يقني‬‫ل‬‫ا‬‫و‬ ، ‫ته‬‫حص‬‫و‬ ‫الصوم‬ ‫بقاء‬ ‫صل‬‫ال‬

36. 36
‫مثهل‬ ‫يقني‬‫ب‬ ‫ال‬‫ا‬ ‫يقني‬‫ل‬‫ا‬ ‫صل‬‫ال‬ ‫هذا‬ ‫يرتك‬ ‫وال‬ ‫يام‬‫لص‬‫ا‬ ‫حصة‬ ‫صل‬‫ال‬ ‫ن‬‫ا‬
‫ن‬‫أ‬ ‫صل‬‫ال‬ ‫ن‬‫ل‬ ‫فيه‬ ‫شكوك‬‫م‬ ‫مر‬‫أ‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫املادة‬ ‫وهذه‬ ‫الرذاذ‬ ‫هذا‬ ‫من‬ ‫يشء‬ ‫ووصول‬
‫مر‬‫أ‬ ‫هذا‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫مهنا‬ ‫يشء‬ ‫فوصول‬ ‫نفيس‬‫ت‬‫ل‬‫ا‬ ‫اجلهاز‬ ‫ىل‬‫ا‬ ‫تذهب‬ ‫املادة‬ ‫هذه‬
‫شك‬‫ل‬‫اب‬ ‫يزول‬ ‫ال‬ ‫يقني‬‫ل‬‫ا‬‫و‬ ‫فيه‬ ‫شكوك‬‫م‬‫حص‬ ‫بقى‬‫ي‬ ‫يام‬‫لص‬‫ا‬ ‫ن‬‫ا‬ ‫نقول‬ ‫تايل‬‫ل‬‫واب‬‫حىت‬ ‫يحا‬
‫املعدة‬ ‫ىل‬‫ا‬ ‫وصل‬ ‫وهذا‬ ‫املادة‬ ‫هذه‬ ‫من‬ ‫جزءا‬ ‫ن‬‫أ‬ ‫يقني‬ ‫ندان‬‫ع‬ ‫ثبت‬‫ي‬

37. 37
•‫س‬‫م‬ ‫غري‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫املادة‬ ‫هذا‬ ‫وصول‬ ‫ن‬‫أ‬ ‫ول‬‫ال‬ ‫القول‬ ‫حصاب‬‫أ‬ ‫يل‬‫ل‬‫ود‬‫مل‬
‫ق‬ ‫نه‬‫ع‬ ‫ا‬‫و‬‫معف‬ ‫جدا‬ ‫سري‬‫ي‬ ‫يصل‬ ‫مفا‬ ‫به‬ ‫سلمي‬‫لت‬‫ا‬ ‫فرض‬ ‫وعىل‬‫بقى‬‫ي‬ ‫ما‬ ‫عىل‬ ‫ياسا‬
‫هللا‬ ‫ند‬‫ع‬ ‫العمل‬‫و‬ ‫احج‬‫ر‬‫ال‬ ‫ن‬‫ا‬ ‫نقول‬ ‫لهذا‬‫و‬ ‫اك‬‫و‬‫س‬‫ل‬‫بعدا‬‫و‬ ‫املضمضة‬ ‫بعد‬‫القول‬ ‫هو‬
‫به‬ ‫الفطر‬ ‫حيصل‬ ‫ال‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫ن‬‫بأ‬

38. 38

39. 39
‫املوضوع‬:‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫تعامل‬‫س‬‫ا‬..‫الصوم؟؟‬ ‫سد‬‫يف‬ ‫هل‬
‫بخاخ‬‫ل‬‫ا‬ ‫هذا‬ ‫ن‬‫أ‬ ‫ين‬‫رص‬‫املعا‬ ‫العمل‬ ‫هل‬‫أ‬ ‫من‬ ‫جامعة‬ ‫اختاره‬‫و‬ ‫الفتوى‬ ‫يه‬‫عل‬ ‫اذلي‬‫و‬
‫؛‬ ‫ا‬‫ر‬ّ‫مفط‬ ‫تب‬‫يع‬ ‫يام‬‫لص‬‫ا‬ ‫ناء‬‫ث‬‫أ‬ ‫بو‬‫ر‬‫ال‬ ‫يض‬‫ر‬‫م‬ ‫تعمهل‬‫س‬‫ي‬ ‫اذلي‬
‫ال‬ ‫ما‬ ‫بني‬‫و‬ ‫رشاب‬ ‫و‬‫أ‬ ‫الك‬‫أ‬ ‫العرف‬ ‫يعده‬ ‫ما‬ ‫بني‬ ‫فرق‬ ‫ال‬ ‫نه‬‫أ‬ ‫العلامء‬ ‫قرر‬ ‫وقد‬‫يعده‬
‫كذكل‬
‫ية‬‫رص‬‫امل‬ ‫فتاء‬‫اال‬ ‫دار‬ ‫موقع‬

40. 40
•‫ا‬ ‫رم‬ِ‫ج‬ ‫ذي‬ ‫يشء‬ ‫بدخول‬ ‫ساك‬‫م‬‫اال‬ ‫تحقق‬‫ي‬ ‫وال‬ ، ‫ساك‬‫م‬‫اال‬ ‫هو‬ ‫الصوم‬ ‫معىن‬‫ىل‬
‫ي‬ ‫ال‬ ‫ركهنا‬ ‫بدون‬ ‫بادة‬‫لع‬‫ا‬ ‫داء‬‫أ‬‫و‬ ، ‫ا‬‫منعدم‬ ‫يام‬‫لص‬‫ا‬ ‫كن‬‫ر‬ ‫اكن‬ ‫ال‬‫ا‬‫و‬ ، ‫اجلوف‬‫تصور‬.
‫اء‬‫و‬‫ه‬ ‫جمرد‬ ‫نه‬‫أ‬ ‫يحا‬‫حص‬ ‫ليس‬‫و‬ ، ‫ثر‬‫ؤ‬‫م‬ ‫جرم‬ ‫هل‬ ‫رذاذ‬ ‫بخاخ‬‫ل‬‫ا‬ ‫من‬ ‫اخلارج‬‫و‬
•‫الصوم‬ ‫سد‬‫يف‬ ‫ا‬‫يار‬‫خت‬‫ا‬ ‫ام‬‫ر‬‫ج‬‫ال‬ ‫من‬ ‫اجلوف‬ ‫يدخل‬ ‫ما‬ ‫لك‬‫يف‬ ‫املعىن‬ ‫ن‬‫ل‬ ‫؛‬‫يع‬‫مجل‬‫ا‬
‫العادة‬ ‫يف‬ ‫منه‬ ‫ناع‬‫مت‬‫الا‬ ‫ماكن‬‫ا‬ ‫مع‬ ‫فيه‬ ‫اره‬‫ر‬‫تق‬‫س‬‫ا‬‫و‬ ‫اجلوف‬ ‫ىل‬‫ا‬ ‫وصوهل‬.

41. 41
‫مفطر‬ ‫تب‬‫يع‬ ‫ال‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫الصامئ‬ ‫تعامل‬‫س‬‫ا‬ ‫ن‬‫أ‬ ‫ين‬‫رص‬‫املعا‬ ‫العلامء‬ ‫بعض‬ ‫ذهب‬‫ا‬‫و‬‫ر‬ّ‫ر‬‫ب‬‫و‬ ، ‫ا‬
‫مهنا‬ ، ‫مور‬‫بأ‬ ‫ذكل‬:
‫ول‬‫ال‬:‫حي‬ ‫فل‬ ، ‫العادة‬ ‫يف‬ ‫رشاب‬ ‫و‬‫أ‬ ‫الك‬‫أ‬ ‫يعتـب‬ ‫ال‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫من‬ ‫حيصل‬ ‫ما‬ ‫ن‬‫أ‬‫صل‬
‫الفطر‬ ‫به‬.
‫نه‬‫بأ‬ ‫ذكل‬ ‫ناقش‬‫ي‬‫و‬‫خيرج‬ ‫ال‬ ‫ذكل‬ ‫ن‬‫فا‬ ‫العادة‬ ‫يف‬ ‫رشاب‬ ‫و‬‫أ‬ ‫الك‬‫أ‬ ‫تب‬‫يع‬ ‫ال‬ ‫اكن‬ ‫ن‬‫ا‬‫و‬‫عن‬ ‫ه‬
‫يه‬ ‫يام‬‫لص‬‫ا‬ ‫وحقيقة‬ ‫ا‬‫يار‬‫خت‬‫ا‬ ‫للجوف‬ ‫اجلرم‬ ‫بدخول‬ ‫فالعبة‬ ، ‫ات‬‫ر‬‫املفط‬ ‫مجةل‬‫ساك‬‫م‬‫اال‬
‫وحتقق‬ ،‫اجلوف‬ ‫ىل‬‫ا‬ ‫جرم‬ ‫ذي‬ ‫دخول‬ ‫نع‬‫مب‬ ‫يكون‬ ‫منا‬‫ا‬ ‫ساك‬‫م‬‫اال‬.

42. 42
•‫ثاين‬‫ل‬‫ا‬:‫ف‬ ‫ا‬‫ي‬‫قطع‬ ‫ليس‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫من‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫يشء‬ ‫دخول‬ ‫ن‬‫أ‬‫وقد‬ ‫يدخل‬ ‫قد‬
‫شك‬‫ل‬‫اب‬ ‫يقني‬‫ل‬‫ا‬ ‫هذا‬ ‫يزول‬ ‫وال‬ ، ‫الصوم‬ ‫حصة‬ ‫صل‬‫ال‬‫و‬ ، ‫يدخل‬ ‫ال‬.
•‫ي‬ ‫اذلي‬ ‫ن‬‫أ‬ ‫ية‬‫ب‬‫لط‬‫ا‬ ‫ناحية‬‫ل‬‫ا‬ ‫من‬ ‫ثبت‬ ‫قد‬ ‫نه‬‫بأ‬ ‫هذا‬ ‫عىل‬ ُّ‫د‬‫ر‬ُ‫ي‬‫و‬‫من‬ ‫املعدة‬ ‫ىل‬‫ا‬ ‫صل‬
‫نف‬‫ت‬‫ل‬‫ا‬ ‫اجلهاز‬ ‫ىل‬‫ا‬ ‫يذهب‬ ‫بايق‬‫ل‬‫ا‬‫و‬ ‫ابملائة‬ ‫نني‬‫امث‬‫ال‬ ‫يقارب‬ ‫اء‬‫و‬‫ادل‬‫يرص‬ ‫فمل‬ ، ‫يس‬
‫فيه‬ ‫اك‬‫و‬‫شك‬‫م‬ ‫للمعدة‬ ‫اء‬‫و‬‫ادل‬ ‫وصول‬.

43. 43

44. 44
Pharmacokinetics of Inhaled Drugs

45. 45
‫ثالث‬‫ل‬‫ا‬:‫ل‬‫ا‬‫و‬ ‫الطعام‬ ‫خمرج‬ ‫ال‬ ، ‫نفس‬‫ل‬‫ا‬ ‫خمرج‬ ‫مع‬ ‫يدخل‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬‫اب‬‫رش‬.
‫فالعبة‬ ‫؛‬ ‫ثر‬‫ؤ‬‫م‬ ‫غري‬ ‫اخملرجني‬ ‫بني‬ ‫الفرق‬ ‫هذا‬ ‫ن‬‫بأ‬ ُّ‫د‬‫ر‬ُ‫ي‬‫و‬‫سمى‬‫ي‬ ‫ما‬ ‫ىل‬‫ا‬ ‫ابلوصول‬
‫اخملرج‬ ‫ىل‬‫ا‬ ‫تفات‬‫ل‬‫ا‬ ‫دون‬ ‫ا‬‫جوف‬.

46. 46
‫ابع‬‫ر‬‫ال‬:‫املضمضة‬ ‫من‬ ‫بقي‬‫ت‬‫مل‬‫ا‬ ‫عىل‬ ‫بو‬‫ر‬‫ال‬ ‫خباخ‬ ‫من‬ ‫اجلوف‬ ‫ىل‬‫ا‬ ‫اصل‬‫و‬‫ال‬ ‫قياس‬
‫شاق‬‫تن‬‫س‬‫والا‬.
‫احل‬ ‫هو‬ ‫منا‬‫ا‬ ‫الصوم‬ ‫عىل‬ ‫ناية‬‫جل‬‫ا‬ ‫به‬ ‫يقصد‬ ‫اذلي‬ ‫احملل‬ ‫ن‬‫ل‬ ‫؛‬ ‫الفارق‬ ‫مع‬ ‫قياس‬ ‫وهذا‬، ‫لق‬
‫ب‬‫ر‬‫ال‬ ‫خباخ‬ ‫يف‬ ‫خبلفه‬ ، ‫الفم‬ ‫هو‬ ‫مقصودها‬ ‫بل‬ ، ‫املضمضة‬ ‫مقصود‬ ‫ليس‬ ‫وهو‬‫ن‬‫فا‬ ‫و‬
‫هل‬ ‫مقصود‬ ‫اجلوف‬.
‫ية‬‫هل‬‫ال‬ ‫ارض‬‫و‬‫ع‬ ‫من‬ ‫هو‬ ‫اذلي‬ ‫اخلطأ‬ ‫ابب‬ ‫من‬ ‫احللق‬ ‫ىل‬‫ا‬ ‫املضمضة‬ ‫ثر‬‫أ‬ ‫رساين‬ ‫فصار‬

47. 47
‫اخلامس‬:‫وجود‬ ‫مع‬ ‫للصامئ‬ ‫تعامهل‬‫س‬‫ا‬ ‫از‬‫و‬‫ج‬ ‫يف‬ ‫اك‬‫و‬‫س‬‫ل‬‫ا‬ ‫عىل‬ ‫بخاخ‬‫ل‬‫ا‬ ‫قياس‬
‫مقصود‬ ‫غري‬ ‫لكوهنا‬‫و‬ ‫لقلهتا‬ ‫؛‬ ‫عهنا‬ ‫عفي‬ ‫قد‬ ‫اليت‬‫و‬ ‫فيه‬ ‫اد‬‫و‬‫امل‬ ‫بعض‬‫ة‬.
‫ع‬ ‫ما‬ ‫هو‬ ‫نه‬‫ع‬ ‫املعفو‬ ‫ن‬‫أ‬ ‫كام‬ ، ‫سابق‬‫ل‬‫ا‬ ‫يل‬‫ل‬‫ادل‬ ‫عن‬ ‫به‬ ‫جيب‬‫أ‬ ‫مبا‬ ‫نا‬‫ه‬ ‫وجياب‬ُ‫ُس‬
‫متعمد‬ ‫مفقصود‬ ‫فيه‬ ‫حنن‬ ‫ما‬ ‫ما‬‫أ‬‫و‬ ، ‫دفعه‬.

48. 48
‫ال‬ ‫تعملها‬‫س‬‫م‬ ‫ن‬‫فا‬ ، ‫ات‬‫ر‬‫املفط‬ ‫جنس‬ ‫من‬ ‫بو‬‫ر‬‫ال‬ ‫خباخة‬ ‫ن‬‫أ‬ ‫تقرر‬ ‫ذا‬‫ا‬ ‫ذكل‬ ‫بعد‬
‫مزم‬ ‫ا‬‫مرض‬ ‫ا‬‫يض‬‫ر‬‫م‬ ‫يكون‬ ‫ن‬‫أ‬ ‫و‬‫أ‬ ‫ا‬‫مؤقت‬ ‫ا‬‫مرض‬ ‫ا‬‫يض‬‫ر‬‫م‬ ‫يكون‬ ‫ن‬‫أ‬ ‫خيلو‬‫ن‬‫فا‬ ، ‫ا‬‫ن‬
‫متك‬‫ل‬‫ا‬ ‫ند‬‫ع‬ ‫القضاء‬ ‫يلزمه‬ ‫نه‬‫فا‬ ‫برؤه‬ ‫يرىج‬ ‫اذلي‬ ‫املؤقت‬ ‫وهو‬ ‫ول‬‫ال‬ ‫اكن‬‫من‬ ‫ن‬
‫تعاىل‬ ‫لقوهل‬ ‫وذكل‬ ‫؛‬ ‫يام‬‫لص‬‫ا‬:
َّ‫د‬ِ‫ع‬‫ف‬ ٍ‫ر‬‫ف‬‫س‬ ‫ىل‬‫ع‬ ْ‫و‬َ‫أ‬ ‫يضا‬ِ‫ر‬َّ‫م‬ ُ‫نُك‬ِ‫م‬ ‫ن‬‫اك‬ ‫ن‬‫م‬‫ف‬‫ر‬‫خ‬‫خ‬‫أ‬ ٍ‫م‬ َّ‫اي‬َ‫أ‬ ْ‫ن‬ِّ‫م‬ ٌ ‫ة‬{‫بقرة‬‫ل‬‫ا‬:185}.

49. 49
‫ل‬ ‫؛‬ ‫يه‬‫عل‬ ‫صوم‬ ‫وال‬ ‫يفطر‬ ‫نه‬‫فا‬ ‫ا‬‫مزمن‬ ‫مرضه‬ ‫اكن‬ ‫ن‬‫بأ‬ ‫برؤه‬ ‫يرىج‬ ‫ال‬ ‫من‬ ‫ما‬‫أ‬‫قوهل‬
‫تعاىل‬:‫ر‬‫ح‬ ْ‫ن‬ِ‫م‬ ِ‫ين‬ِّ‫دل‬‫ا‬ ِ‫يف‬ ْ ُ‫ُك‬ْ‫ي‬‫ل‬‫ع‬ ‫ل‬‫ع‬‫ج‬ ‫ا‬‫م‬‫و‬ٍ‫ج‬{‫احلج‬:78}‫عن‬ ‫الفدية‬ ‫يلزمه‬‫و‬ ،
‫مثل‬ ‫رز‬‫اكل‬ ‫بدل‬‫ل‬‫ا‬ ‫قوت‬ ‫من‬ ‫طعام‬ ‫من‬ ‫مد‬ ‫مقداره‬ ‫مبا‬ ‫سكني‬‫م‬ ‫طعام‬‫ا‬ ‫يوم‬ ‫لك‬
‫ساوي‬‫ي‬ ‫املد‬‫و‬ ،510‫ما‬ ‫عىل‬ ‫سكني‬‫للم‬ ‫ودفعها‬ ‫ميهتا‬‫ق‬ ‫اج‬‫ر‬‫خ‬‫ا‬ ‫وجيوز‬ ، ‫مج‬
‫عمل‬‫أ‬ ‫تعاىل‬ ‫وهللا‬ ، ‫الفتوى‬ ‫يه‬‫عل‬.

50. 50
‫حاةل‬ ‫و‬‫أ‬ ‫عضال‬ ‫مرض‬ ‫سبب‬‫ب‬ ‫يام‬‫لص‬‫ا‬ ‫يع‬‫تط‬‫س‬‫ي‬ ‫ال‬ ‫ملن‬ ‫سموح‬‫م‬ ‫الافطار‬ ‫ان‬
‫وكف‬ ‫املرضع‬‫و‬ ‫احلامل‬ ‫يه‬‫عل‬ ‫يقاس‬‫و‬ ‫لصاحبه‬ ‫يا‬‫حص‬ ‫مرض‬ ‫يام‬‫لص‬‫ا‬ ‫جتعل‬‫ته‬‫ر‬‫ا‬
‫سكني‬‫م‬ ‫اطعام‬
‫تعاىل‬ ‫لقوهل‬:‫خ‬ ‫تطوع‬ ‫مفن‬ ‫سكني‬‫م‬ ‫طعام‬ ‫فدية‬ ‫نه‬‫و‬‫يق‬‫يط‬ ‫اذلين‬ ‫وعىل‬‫فهو‬ ‫ا‬‫ري‬
‫هل‬ ‫خري‬
‫بقرة‬‫ل‬‫ا‬ ‫سورة‬–‫ية‬‫أ‬184

51. 51
‫رمضان؟‬ ‫هنار‬ ‫يف‬ ‫بو‬‫ر‬‫ال‬ ‫ملرىض‬ ‫بخاخ‬‫ل‬‫ا‬ ‫خذ‬‫أ‬ ‫حُك‬ ‫ما‬
•ٌ ‫مفطر‬ ‫الفم‬ ‫و‬‫أ‬ ‫نف‬‫ال‬ ‫يق‬‫ر‬‫ط‬ ‫عن‬ ‫بخاخ‬‫ل‬‫ا‬ ‫خذ‬‫أ‬‫ل‬‫ا‬ ‫هذه‬ ‫يف‬ ‫اء‬‫و‬‫ادل‬ ّ‫ن‬‫ل‬ ‫؛‬‫اد‬‫ر‬ُ‫ي‬ ‫بخاخات‬
،‫اجلوف‬ ‫من‬ ‫وهام‬ ‫تني‬‫ئ‬‫ر‬‫ال‬ ‫ىل‬‫ا‬ ‫الوصول‬ ‫منه‬
•‫ي‬‫عل‬‫و‬ ‫صومه‬ ‫سد‬‫ف‬ ‫رمضان‬ ‫ايم‬‫أ‬ ‫بعض‬ ‫يف‬ ‫تعامهل‬‫س‬‫ا‬ ‫ىل‬‫ا‬ ‫اضطر‬ ‫مفن‬‫ساك‬‫م‬‫اال‬ ‫ه‬
‫ي‬ ‫وال‬ ‫يوم‬ ‫لك‬ ‫تعمهل‬‫س‬‫ي‬ ‫اكن‬ ‫ومن‬ ،‫رمضان‬ ‫بعد‬ ‫يقيض‬‫و‬ ،‫شهر‬‫ل‬‫ا‬ ‫حلرمة‬‫نه‬‫ع‬ ‫تغين‬‫س‬
‫طع‬ُ‫ي‬‫و‬ ‫ساك‬‫مم‬ ‫بقى‬‫ي‬‫و‬ ‫رمضان‬ ‫هنار‬ ‫يف‬ ‫تعمهل‬‫س‬‫ي‬ ،‫العام‬ ‫مدار‬ ‫عىل‬‫يوم‬ ‫لك‬ ‫عن‬ ‫م‬
‫يه‬‫عل‬ ‫قضاء‬ ‫وال‬ ،‫نا‬‫سكي‬‫م‬.

52. 52
‫نفس‬‫ت‬‫ل‬‫ا‬ ‫جلهاز‬ ‫الصامئ‬ ‫تعامل‬‫س‬‫ا‬ ‫ثر‬‫ؤ‬‫ي‬ ‫هل‬(‫سجني‬‫ك‬‫ال‬)‫رمضان‬ ‫هنار‬ ‫يف‬‫حصة‬ ‫عىل‬
‫الصوم؟‬
‫اء‬‫و‬‫ه‬ ‫سجني‬‫ك‬‫ال‬ ‫ن‬‫ل‬ ‫الصوم؛‬ ‫حصة‬ ‫عىل‬ ‫سجني‬‫ك‬‫ال‬ ‫هجاز‬ ‫تعامل‬‫س‬‫ا‬ ‫ثر‬‫ؤ‬‫ي‬ ‫ال‬،‫هل‬ ‫جرم‬ ‫ال‬
‫يف‬ ‫تعامهل‬‫س‬‫ا‬ ‫بح‬‫يص‬ ‫جرم‬ ‫لها‬ ‫علجية‬ ‫مادة‬ ‫سجني‬‫ك‬‫لل‬ ‫يف‬‫ض‬‫أ‬ ‫ذا‬‫ا‬ ‫لكن‬‫و‬‫رمضان‬ ‫هنار‬
‫تاد‬‫مع‬ ‫منفذ‬ ‫من‬ ‫اجلوف‬ ‫ىل‬‫ا‬ ‫دلخوهل‬ ‫ا‬‫ر‬‫مفط‬.

53. •‫من‬ ‫اخلروج‬ ‫لون‬‫و‬‫يق‬ ‫العمل‬ ‫هل‬‫أ‬‫و‬ ‫العمل‬ ‫هل‬‫أ‬ ‫بني‬ ‫خلف‬ ‫وهذا‬
‫يؤخر‬ ‫ن‬‫أ‬ ‫مثل‬ ‫بو‬‫ر‬‫ال‬ ‫يض‬‫ر‬‫مل‬ ‫مكن‬‫أ‬ ‫ذا‬‫فا‬ ‫تحب‬‫س‬‫م‬ ‫اخللف‬‫تعاطي‬
‫ال‬ ‫نا‬‫قل‬ ‫رضر‬ ‫وال‬ ‫شقة‬‫م‬ ‫ذكل‬ ‫عىل‬ ‫تب‬‫رت‬‫ي‬ ‫وال‬ ‫بخاخ‬‫ل‬‫ا‬ ‫هذا‬‫نه‬‫أ‬ ‫فضل‬
‫نقول‬ ‫نا‬‫ن‬‫فا‬ ‫يه‬‫ل‬‫ا‬ ‫احتاج‬ ‫ذا‬‫ا‬ ‫لكن‬ ‫اخللف‬ ‫من‬ ‫خروجا‬ ‫يؤخره‬‫نه‬‫ا‬
‫نه‬‫ا‬‫بح‬‫س‬ ‫املوىل‬ ‫ند‬‫ع‬ ‫العمل‬‫و‬ ‫بذكل‬ ‫الفطر‬ ‫حيصل‬.

54. 54
According to the scecond view, If your disease is
unstable or poorly controlled & such medication needs
to be taken during the time of fasting, you are advised
not to fast.
If medication is required on a long-term basis as part of an
ongoing illness or condition such as high blood pressure
or diabetes, then you may discuss with your GP to change
your medication to a long acting variety as appropriate, to
enable you to take it outside the time of the fast.

55. 55
Can I adjust my asthma
medicine to suit my fast?

56. 56

57. 57
Adjustment of the drug doses seems to be a way of using
medications for fasting patients , therefore, the most
common adjustments are taking a single daily dose and
two in allowed eating times
The majority of these patients adjusted to use their
controller inhaled medications in ‘‘sahur’’ and ‘‘iftar’’ times
during the month of Ramadan.
This approach seems to be reasonable when compared to
the hazardous alternative of quitting all the drugs.
.

58. 58
However, it is of interest whether the efficacy of the
drugs differs when they are used in this way.
In the traditional approach, inhaled steroids other
than ciclesonid and mometasone are recommended
twice daily with 12 h apart. .

59. 59
The interval between the ‘‘iftar’’ and ‘‘sahur’’ differs according
to the season of Ramadan month corresponded , It is longer
than 12 h during summer months whereas a shorter period
for fasting is available during winter months.
Based on data about pharmacokinetics & pharmacodynamics
of inhaled steroids ,this type of recommendations is not
expected to have a change in efficacy of inhaled steroids
in asthma.

60. 60
Other maintenance treatment options of anti-leukotriens
or theophyllines are available in the form of once daily
use which allows them to be used confidently in fasting.
A recent study recommended to use a long acting
formulation of teophylline taken once daily in order to
reduce side-effects in asthmatic patients during Ramadan.
.
.

61. 61
Taken together, all inhaled asthma medications used in
iftar and sahur times are not expected to decrease the
efficacy of the drugs and this way seems to be acceptable
for patients who do not want to use their drugs during
fasting hours.
The use of controller treatment in ‘‘iftar’’ and ‘‘sahur’’
times of the Ramadan month allow subjects to use their
medications without any interruption of the treatment.
.
.

62. 62
In patients with asthma who prefer not to use inhalers
during fasting hours, one should consider switching to a
regimen of a long-acting beta-2 agonist and a twice-daily
inhaled corticosteroid dose prior to and after the fast.
Actually, considering the fact that quitting the medications
during fasting can cause much more harmful effects on
disease activity, this advice seems to be a reasonable
approach for better disease control.

63. 63
Even if you don't plan to use your inhalers during the
fasting period, always carry your reliever inhaler (usually
blue) with you at all times in case of an emergency.
If you have adjusted your medicines for fasting and you
begin to feel worse, please see your doctor or as soon
as you can.

64. 64
A considerable proportion of patients with chronic
illness change their medication regimens during fasting
without asking their physician .
Therefore, appropriate advice from doctors during
Ramadan may encourage patients to continue their
treatments and prevent major health issues.

65. 65
Ramadan an occasion to educate patients:
Smoking is bad for your health and Ramadan is a great
opportunity to change unhealthy habits, including smoking
Informing people about the dangers of smoking and other
addicting habits and helping them to quit during this
month should be one of our concerns.

66. 66

67. 67

68. 68
Treatment of Asthma in Holy Ramadan
for Muslim
• Long term inhalers like salmeterol ,formoterol, ICS ,
and other daily preventive medications are prescribed
only twice /day which is convenient to your fasting
when stable Asthma
• You are authorised and even recommended not to fast
during exacerbation because you are ill or sick (Surat
Al- Baqarah in the Holy Quran)
• Take the opportunity to quit smoking in Ramadan

69. 69

70. 70