Ramadan fasting for patients with chronic respiratory diseases: a systematic review and consensus recommendations for healthcare professionals

Background: Ramadan, observed by nearly 2 billion Muslims worldwide, involves fasting from dawn to sunset, which can present challenges for individuals with chronic respiratory diseases due to altered medication regimens and oral intake restrictions. This study aimed to synthesise current evidence and develop consensus recommendations for managing asthma, COPD, interstitial lung disease (ILD) and bronchiectasis during Ramadan. Methods: A comprehensive search of electronic databases including MEDLINE, Embase and Google Scholar was conducted following a pre-specified protocol (PROSPERO identifier number CRD42024532759) to identify studies on Ramadan fasting outcomes in individuals with chronic respiratory diseases. The findings informed consensus recommendations stratified by the risk of adverse outcomes using International Diabetes Federation and the Diabetes and Ramadan risk assessment criteria. An international expert group of medical and religious experts refined these guidelines, achieving consensus approval. Results: 11 studies met the inclusion criteria, primarily addressing asthma and COPD, with no relevant studies on ILD or bronchiectasis. The studies indicated that fasting did not significantly impact hospitalisation rates or lung function tests in individuals with stable asthma and COPD. However, small sample sizes and methodological limitations restricted generalisability. 19 recommendations were developed to support patients considering fasting, emphasising pre-Ramadan consultations, individualised risk assessments, and adjustments to medication regimens. Conclusion: This systematic review highlights the need for larger, well-designed studies to understand Ramadan fasting implications across chronic respiratory diseases. The developed recommendations provide a structured approach to assess fasting risks, ensuring informed and safe guidance during Ramadan. Future research should address identified gaps, supporting evidence-based guidelines that reconcile medical and religious considerations.