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19/7/12  www.asthma.org.uk

Asthma UK have produced the following information to help people fasting.

Fasting is willingly abstaining from some or all food, drink, or both, for a period of time. An absolute fast is a complete abstinence from all food and liquid for an amount of time. Other fasts may only limit particular foods or substances. Fasts may also be partial in nature, for example for a set period each day for a set length of time, such as Ramadan. Fasting may preclude sexual intercourse and other activities like smoking and drinking alcohol.

Who fasts?

Fasting and asthma 2

 

Fasting, in one form or another, has always been an important and often necessary part of religious life, discipline and experience in every faith, including among others: Christianity and the sacrifices of Lent; Greek Orthodox Christianity and the fasting periods of the Nativity Fast, Lent and the Assumption; the Muslim holy month of Ramadan; Judaism, which mandates penitential fasting on Yom Kippur along with fasting on sad days such as Tishah B’Av, as well as fasting on certain other days of the year which mark sad events.

Fasting is not just a religious activity and people also fast for political reasons, as well as for purposes of health and wellbeing.

Fasting and asthma

Evidence suggests that few health problems arise because of partial fasting (fasts that are restricted to certain periods of the day and/or the restriction on certain types of foods or additives). It also suggests that people often choose not to take their medicines or to take them in a different way when fasting. People also often choose not to attend medical appointments during their fast.

There is little to suggest that fasting causes problems for asthma specifically except that it can change the way people manage or control their asthma.

Some people may consider that using an inhaler would break their fast.

Ramadan

It is especially important for Muslim people from South Asian communities to look after their asthma during Ramadan.

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,despitethe fact that the incidence of asthma in South Asian communities is actually lower than in the white population.

Although Islamic rules state that people with long-term conditions are permitted not to fast[¹], some Muslims with asthma still choose to observe Ramadan and may consider using an inhaler to be breaking their fast.

Things to consider

You should discuss your plans for fasting with your doctor or asthma nurse before making any decisions. They will help you adapt your medicines if necessary. Asthma UK suggests that you do not stop taking your asthma medicine without speaking to your doctor first. You should expect to be able to adjust your medicine to suit your plans, with medical advice.

It may be possible to change to long-acting medicines or to change when you take your medicines. You should talk to your doctor or asthma nurse about this and make any changes well before you start your fast and have an asthma review again before your fast starts to ensure that you are well controlled on your new medicine. An asthma review is an annual checkup (six monthly for children) with your doctor or asthma nurse to make sure that your asthma is under control and that you are happy with your treatment.

If you are not allowed to drink during your fast be aware that dehydration can dry the airways and may make your asthma worse when you are not drinking. This could be particularly true if you are triggered by exercise.

Even if you do not plan to use your inhalers, you should carry your blue reliever inhaler with you at all times in case of an emergency. If you do have an asthma attack it could save your life.

Try to plan any medical appointments before or after your fast. If during your fast you notice your asthma getting worse seek medical help.

To help you monitor your asthma you should have a personal asthma action plan. This is a written plan, which you fill out in discussion with your doctor or asthma nurse, containing the information you need to control your asthma, details of your asthma medicine, how to know when your asthma is getting worse and what to do if it does, as well as emergency information if you have an asthma attack. This plan can be adapted so that it includes details of what to do when fasting.

Specialist advice

Spiritual leaders

Mohammed Zubair Butt, Islamic scholar from Muslim Council of Britain, says:

  • ‘Oral inhalers will invalidate your fast because the medicine reaches the throat [cavity of consequence] (and possibly further down the digestive tract) via the mouth [orifice of consequence]. In addition nebulisers also invalidate your fast because the mist inhaled is a mixture of gas and liquid particles in the form of small aerosol droplets which reach the throat [cavity of consequence] via the mouth [orifice of consequence]. Those wishing to fast during Ramadan should consult their GP as to whether it is safe for them to do so or whether it is safe and reasonable to adjust their medicines in line with Asthma UK’s advice. If it is not, the guidance is that you make such fasts up later if possible, such as in the smaller days of winter. Otherwise you should pay the appropriate compensation for each fast.’

Rabbi Michael Laitner, assistant rabbi at Finchley United Synagogue and coordinator of United Synagogue ‘Living & Learning’ department notes that:

  • ‘Yom Kippur, a day when we fast so we can focus on spiritual matters over physical ones, along with Tisha B’Av, when we fast to express sadness, are the principal fasts in the Jewish calendar. Fasting is not primarily about physical privation. If you have any health concerns related to fasting, such as taking medicine or if you are diabetic, asthmatic or pregnant, for example, you must consult with your doctor and a rabbi in advance of a fast for advice as to whether you are obligated to fast or not.’

Asthma nurse specialist

Erica Evans, Clinical Lead at Asthma UK, offers the following advice for people with asthma who are fasting:

  • ‘If you are fasting speak to your religious leader or fast advisor for advice – if you choose not to use your inhalers in daylight hours it is usually quite reasonable to alter the time of your medicines as long as you discuss it with your doctor. If you have adjusted your medicines for your fast and you begin to feel worse, please see your doctor or asthma nurse as soon as you can. Even then, it won’t necessarily mean breaking your fast as long as you explain your needs to your doctor. ‘

Where to get more advice

For further advice speak to:

  • your doctor or asthma nurse at your local surgery
  • the Asthma UK Adviceline on 0800 121 62 44 (9am-5pm , Monday to Friday) and speak in confidence with one of our asthma nurse specialists.
  • your religious leader or fast advisor, eg, your Imam, Priest, Rabbi, therapist etc.

References

Effects on health of fluid restriction during fasting in Ramadan

Leiper JB, Molla AM, Molla AM. Department of Biomedical Sciences, University Medical School, Aberdeen University, UK. j.leiper@abdn.ac.uk

Islamic fasting and health

Azizi F. (Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran. azizi@endocrine.ac.ir)

The impact of religious fasting on human health

Trepanowski JF, Bloomer RJ. (Cardiorespiratory/Metabolic Laboratory, The University of Memphis, Memphis, TN 38152, USA.)

Caring for Muslim Patients

Edited by Aziz Sheikh and Abdul Rashid Gatrad OBE (Radcliffe)


[¹]  In Ramadan fasting is the complete abstinence from food and drink between dawn and dusk. All those who are ill or frail, pregnant or menstruating women, breastfeeding mothers and travellers are exempted. They are required to make up the number of days missed at a later date or give a fixed sum to charity.

– Ramadan Health Guide by Communities in Action

http://www.asthma.org.uk/about-asthma/living-with-asthma/fasting-and-asthma/


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