How to manage asthma during Ramadan?

When Muslims fast in Ramadan, they abstain from eating, drinking and smoking from sunrise (sehour) to sunset (Fetour or Iftar). Many Muslims also abstain from taking prescription medication during the fasting hours. This has significant implications for asthma management since to maintain asthma control patients should continue to take their preventer inhalers (ICS±LABA) as prescribed or risk acute exacerbations and even death. Islamic jurisprudence is not unanimous on whether inhalers invalidate fasting or not. The controversy is related to how the inhalers are classified. Some Muslim scholars believe that inhalers do not break the fast because of the gaseous nature of the inhaled agents. Other scholars disagree. They state that since the inhaled gases pass through the mouth and precipitate on the mucosa, they mimic food products. Consequently, they believe the use of the inhalers breaks the fast. It is important to assist patients deal with this dilemma. One approach is to help patients with the timing of their inhaler use. Most preventer asthma medications are prescribed twice daily. With good timing, patients can stick to their therapeutic regimens and still observe fasting. They can take daily preventer inhalers of ICS or ICS+LABA at Sehour and Fetour. Another approach is to remind patients that Islam is flexible and allows special consideration for patients suffering from serious illnesses or conditions, including uncontrolled asthma, asthmatic attacks, and other chronic diseases. These individuals, according to the holy Qur'an, are allowed not to fast or to break their fast and take their medications if they develop acute attacks or complications. Patients can make these days up by fasting later during the year a number of days equivalent to the number of days they had not fasted. Alternatively, if they still are not able to fast, they get redemption by feeding a poor person. Physicians should educate patients about the importance of adherence to preventer therapy during the month of Ramadan .The latter may be a golden opportunity for patients to stop smoking, a process that can be enhanced by compassionate education from the physician. Asthma in Ramadan should be considered in curriculum of nursing, pharmacy, and Medical schools.