This document discusses the effects of Ramadan fasting on asthma patients. It notes that while patients are generally exempt from fasting due to their disease, many still choose to fast. Studies have shown mixed results on the effects of fasting on pulmonary function and immune systems. The document also discusses guidelines on medication adjustments and recommendations for asthma patients who fast, such as staying hydrated and avoiding triggers. Religious rulings on the permissibility of using inhalers during fasting hours are presented.

1. Fawzia Abo Ali
Faculty of Medicine
Ain Shams university

2. Ramadan, the ninth month of the Islamic
lunar calendar, is observed by approximately
1.8 billion Muslims worldwide as a month of
fasting which is one of the five pillars of Islam
During daylight hours (13-26), Muslims
abstain from eating any food, drinking any
liquid, and some other physical needs.This
restriction also includes oral medications

3. Patients and RamadanPatients and Ramadan
• Patients are exempted
from fasting because of
ongoing disease . (Athar, 1990)
• several patients with
chronic conditions do not
accept these exemptions
and prefer fasting during
Ramadan.

4. Asthma in Ramadan
Asthma is one of the most prevalent chronic
diseases worldwide.
• It is clear that the majority of the asthmatic
patients are not concern that asthma is a
problem during the state of fasting
• They enter in the Ramadan fasting by
rearranging their medication times
to iftar and suhoor (Erkekol et al., 2006).

5. Effect of fasting on asthma:
1. Effect on pulmonary function
2. Effect on immune system
3. Autophagy

6. Effect of Ramadan interrmittent fasting on
pulmonary function
Previous studies showed reduced pulmonary function in fasting
volunteers during 1st week and last week of fasting, with
increase in pulmonary function 1st week post breaking

7. . Askari V.Ri, et alAllergologia et al .2016, Immunopathologia, Volume 44,
Issue 4,

8. • In India ,a study showed, There were no significant
alteration in spirometry readings in relation to
Ramadan fasting Annals of Medical Physiology ,2018

9. An Egyptian study showed that none
of the pulmonary function test
(PFT) and arterial blood gas
(ABG)analysis parameters changed
significantly during fasting
Abdelaziz EA, Ibraheem AS. Fasting during Ramadan: does it
alter pulmonary functions in healthy males? AlAzhar Assiut
Med J. 2008 Sep; 6(3):52-63

10. • studies showed that fasting in patients with
asthma has no effect on pulmonary function and
asthma severity
• While others showed that fasting increases lung
volumes and might improve pulmonary function.
This finding seems to be relevant to the changes
in weight during Ramadan.
• Seyyed-Ali et al.Saudi Med J. 2007 Nov; 28(11): 1666–1670.

11. Effect on immune system
• Ramadan fasting could be perceived as a
stressor leading to alteration of immune
system.
• Immediate hypersensitivity reaction was
significantly suppressed by fasting.
• A significant reduction in mast cells
degranulation, induced by mast cell
activator was observed.

12. Adawi, M., Watad, A., Brown, S., Aazza, K., Aazza, H., Zouhir, M., …
Mahroum, N. (2017). Ramadan Fasting Exerts Immunomodulatory
Effects: Insights from a Systematic Review. Frontiers in Immunology, 8.

13. RIF & autophagy
During fasting, the blood glucose levels drop, and therefore, the
production of insulin that delivers glucose to body tissues slows
down. For the human body, it means that the nutrient supply stops
and it has to go into survival mode, meaning that glucagon
production begins, the key function of which is the stimulation
of autophagy.

17. • Study 1: Intermittent Fasting in Asthma Patients
Alternate-day fasting (<500 calories every other day)
• The participants then started their alternate day fasting
intervention, which lasted two months. the
participants’ asthma symptoms and airway resistance
improved and their markers of inflammation and
oxidative stress went down. This improvement even
persisted for up to two months Johnson et al. 2006

18. • Contrary to that:
• Statistics tell us that people from
South Asian communities are
generally three times more likely
than white people to have an
emergency hospital admission for
their asthma during Ramadan .

19. To fast or not to fast?To fast or not to fast?
Others, like the England
National Health Service
(Information for health-care professionals
on fasting and medicines during
Ramadan, n.d.), consider that RIF
is unsafe for patients with
asthma and/or COPD, since
they may experience
complications.
Some societies the
international COPD coalition
(Role of the International COPD,
n.d.), judge it to be safe and
advise patients to rearrange
their medication times
to iftar and suhoor and to
break the fasting during
exacerbation.

20. When asthma patient exempt from
fasting
• Severe, uncontrolled
asthma ,exacerbation
• Resp. infection
• Hot weather
• Pregnancy & lactation
• if a patient feels unwell
• Co-mobidities
• others

21. Ramadan fasting & asthma
medications:

22. • Sheikh Abdul-`Azeez Ibn Baz The Saudi
scholar:
• The use of inhaler is permissible in case of
necessity, based on the verse: “… and He has
already made plain to you what He has
forbidden to you– excepting what you are
compelled to…” (Al-An`am 6:119)
• Ibn Othaymeen: told the same,added
Now, we have long acting inhalers which
could be used after sunset and before dawn.

23. • Using asthma inhalers during the fasting
hours of Ramadan
These inhalers contain a pressurized inactive
gas. They invalidate fasting because they carry
liquid medicine in the form of droplets which
reach the stomach.
• Mohammed Zubair Butt, Islamic scholar from
Muslim Council of Britain: ‘Oral inhalers and
nebulisers will invalidate your fast .
• India Fatwa: Asthma inhaler is a solution that
reaches the throat, and therefore it will
undoubtedly reach the stomach.

24. Turkish Presidency of Religious Affairs :
• “Inhalers that are used to treat lung diseases spray
very small amount. It may reaches the stomach
with saliva. Comparing to the water remaining in
mouth during ablution, it is clear that remainder
of the inhaler is very little. Those sprays won’t
break their fast.”

25. Instructions for asthma patients during
Ramadan
Patient should adjust medicine to suit his
plans, with medical advice.
It may be possible to change to long-acting
medicines or to change time of taking
medicines.
changes starts before fast starts.
If asthma symptoms are getting worse seek
medical help straightaway.
Always carry reliever inhaler .

26. Stay hydrated
dehydration can dry the airways and may make
asthma worse.
This could triggered by exercise..
Avoid hot, dusty places
Avoid stresses and excessive physical efforts.
Avoid eating hot spices and sauces during Aliftar.
Drink plenty of water between breakfast and
suhoor.
Adjust your medications ,dont skip and have
written asthma action plan

27. Stay hydrated again:
As Ramadan falls at
the beginning of
summer, remain
hydrated in hot
weather, particularly
if undertaking heavy
work or exercise.