For Muslims and for many others, fasting is a means through which we grow ever closer to God by cultivating compassion and discipline in our daily lives. Indeed, it is an act of worship that is beloved to Allah (1). In Islam, fasting ultimately entails refraining from eating and drinking from sunrise to sunset (2). Those who are ill, frail, pregnant, breastfeeding, menstruating, or travelling are exempt from fasting (3). It is also well established that pills or tablets break the fast since they are ingested and absorbed through the digestive tract (2). Therefore, sick patients (e.g. diabetics) with strictly dosed medications between sunrise and sunset are also usually exempt from fasting (3).
However, asthma is a very common condition that can be easily managed, depending on its severity, with inhalers alone. Given that fasting during Ramadan is mandatory for Muslims and many would love to partake in this act of worship, physicians should be aware of whether or not the use of inhalers invalidates a patient’s fast, in order to advise them accordingly.
The consensus among scholars is that inhalers or puffers (e.g. SABA, LABA, ICS) and/or oxygen used to manage respiratory conditions such as asthma and COPD do NOT invalidate any fast, and this, for several reasons.
- The active medication in the inhalers is delivered by air through the mouth, trachea, and directly into the lungs, not the stomach, unlike pills. (2, 4, 5)
- Little to no medication reaches the stomach.
- If a minute amount does reach the stomach it is significantly less than the water that remains in the mouth after ablution or using the miswak (similar to toothbrush) which do not break one’s fast. (6, 7)
- There is no evidence to suggest that any medication from puffers or inhalers enters the digestive tract by mixing with saliva. (7)
For these reasons, the majority of scholars have concluded that using inhalers, puffers, or oxygen while fasting does NOT invalidate the fast. That being said, if a patient is seriously ill, they are recommended to break their fast and receive the treatment they require immediately. (6)
Of note: any medication that is delivered in a vaporized or inhaled powder form may invalidate the fast, for its contents (water or powder respectively) are more likely to reach the stomach either directly or by mixing with saliva. (6)
In order to ensure that patients fast safely (4), please recommend:
- Seeking the advice of their physician before deciding to fast if they have a medical condition.
- Booking an appointment with their physician before Ramadan to make any necessary adjustments (e.g. timing, frequency of doses) to their medication.
- Carrying a rescue or reliever inhaler at all times in case of an emergency where it can be life-saving.
- Speaking to their religious leader for more detailed questions, concerns, and reassurance.
Allah knows best.
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