Allergologia et Immunopathologia

Allergologia et Immunopathologia

Volume 42, Issue 2, March–April 2014, Pages 115-119
Allergologia et Immunopathologia

Original article
How do patients with asthma and COPD behave during fasting?

https://doi.org/10.1016/j.aller.2012.07.010Get rights and content

Abstract

Background-objective

Several factors might affect the adherence to treatment in patients with asthma and COPD. Among these factors, the effect of religious beliefs and behaviours has been less studied so far. In this study, the effect of fasting on drug use behaviours of patients with asthma and COPD were comparatively analysed.

Methods

A total of 150 adult patients with asthma and 150 adult patients with COPD were consecutively enrolled into this cross-sectional study. The patients were asked whether they fast during Ramadan and if the answer was yes, they were kindly asked to respond to further questions related to use of inhaled medications during that particular time.

Results

The majority of the cases from both groups [98 (65.3%) of asthma patients and 139 (92.6%) of COPD] were fasting during Ramadan. The majority of the patients with COPD (n = 126; 90.6%) reported that they quitted their regular therapy basis during Ramadan. On the other hand, the majority of asthma patients used their controller inhaled medications during Ramadan and preferred to use them on iftar and sahur times (n = 81, 82.6%).

Conclusion

Our results showed that in a Muslim population, the patients with asthma and COPD do not feel their diseases to be an inhibitory factor for fasting during Ramadan. However, fasting seems to be an important determining factor in medication compliance by modifying the drug use behaviours in each group in a different way. Therefore, the patients should be informed about the effects of fasting on their disease and the allowed drugs during fasting.

Introduction

Chronic airway diseases such as asthma and chronic obstructive pulmonary disease (COPD) are among the most common respiratory diseases, affecting an estimated 300 million plus people all around the world.1, 2 Asthma and COPD guidelines recommend regular use of medications for controlling symptoms, together with patient education, patient monitoring, and avoidance of risk factors.1, 2 However, it has been reported that a significant number of asthma and COPD patients do not fully adhere to treatment. Drug-related factors, such as difficulties with inhaler devices, adverse effects, and cost of the treatment, are the main causes for incompliance to inhaled medications.1 Incompliance with inhaled medications may also be due to personal and social factors. Among these factors, the effect of religious beliefs and behaviours has been less studied so far in patients with obstructive pulmonary diseases.

Muslims fast at a certain time of a year, called Ramadan. During this time, healthy Muslims are expected to eat and drink nothing from sahur (before sunrise) to iftar (sunset) time. This restriction also includes medications given via oral and parenteral route. However, the drugs used via inhalation route are allowed.

Although the relation between religion and health and particularly effect of fasting on chronic diseases has been an interesting issue for physicians nearly for 25 years, this issue was only studied in a very limited number of patients with chronic airway diseases in which regular medication intake has been very important in order to gain symptom control.3 In our previous study, we demonstrated that most Muslim asthmatics did not consider asthma to be a drawback to fasting, and they continued fasting by rearranging their medication times on iftar and sahur.3 Although some overlaps might occur, asthma and Chronic Obstructive Pulmonary Diseases (COPD) differ in many aspects, patient and disease characteristics being one of them. This discrepancy might cause different disease medication use behaviours. Thus, it could be of interest to study both the infuence of fasting on drug use behaviours of patients with COPD and compare the behaviours of patients with asthma and COPD. So, in this study, we aimed to investigate the effect of fasting on drug use behaviour in patients with asthma and COPD and to see whether the patients from both diseases differ in terms of drug use during fasting.

Section snippets

Patient selection and the study design

The study was conducted in Allergy and Pulmonology clinics of a university hospital between 1 June 2009 and 1 June 2010. A total of 150 adult patients with asthma and 150 adult patients with COPD were consecutively enrolled into this cross-sectional study. Asthma diagnosis was based on a history of recurrent symptoms of wheezing, shortness of breath, cough, and demonstration of objective signs of reversible airway obstruction by means of at least > 12% and 200 ml increase in FEV1 after 15 min with

Study group

The study consisted of consecutively enrolled asthma (n = 150) and COPD (n = 150) patients. Older and male subjects dominated in COPD group in comparison to the asthma group (Table 1). In contrast, asthma patients included more female subjects with younger age. Asthma patients had a higher educational level, more rhinitis, chronic sinusitis, nasal polyps, tyroid diseases, depression, and gastric diseases as comorbid diseases (Table 1). The patients with COPD had more cardiac co-morbidities.

Discussion

Our results showed that in a Muslim population, the patients with asthma and COPD do not feel their diseases to be an inhibitory factor for fasting during Ramadan. However, fasting seems to be an important determining factor in medication compliance by modifying the drug use behaviours in each group in a different way.

The month of Ramadan is the nineth month of the lunar calender. Fasting includes neither eating nor drinking during the day.6, 7 The patients with chronic illness are allowed not

Protection of human subjects and animals in research

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this investigation.

Patients’ data protection

Confidentiality of Data. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.

Right to privacy and informed consent

Right to privacy and informed consent. The authors have

Conflict of interest

None of the authors have a conflict of interest and any kind of financial or editorial support.

Contributions

The authors made the following contributions to the study:

  • Ömür Aydin: Study design, inclusion of asthma patients, data entrance, writing manuscript.

  • Gülfem Çelik: Study design, inclusion of asthma patients, statistical analysis, writing manuscript.

  • Zeynep Pınar Önen: Study design, inclusion of COPD patients, significant contribution to written manuscript.

  • İnsu Yilmaz: Study design, inclusion of asthma patients, significant contribution to written manuscript.

  • Seçil Kepil Özdemir: Study design,

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