Effects of Ramadan Fasting on Spirometric Values and Clinical Symptoms in Asthmatic Patients

Document Type : Research Paper


1 Biochemistry of Nutrition Research Center and Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran, 91779-48464

2 Lung and Tuberculosis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, 91379-13316


Introduction: Ramadan is the 9th  Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset.  The effect of Ramadan intermittent fasting on asthma control is controversial.  The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. Methods: a cohort study was conducted in Mashhad, Khorasan Razavi, Iran.
Twenty-nine (19 females and 10 males) well-controlled asthmatic patients aged 47 (12) years completed the study.  The average duration of fasting was 26.5 days. Assessment of spirometric variables (daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring ) as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. Results: No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting.  Among spirometric variables, only peak expiratory flow improved after Ramadan (p <0.05).  There was a reduction in the mean peak expiratory flow variability from 13% at the first week of fasting to 10% at the fourth week (p <0.05). Conclusion: In well-controlled asthmatic patients, Ramadan fasting resulted in improvement in peak expiratory flow and peak expiratory flow variability.


  1. Azizi F. Islamic fasting and health. Ann Nutr Metab 2010; 56 (4): 273-82.       
  2. Joosoph J, Abu J, Yu SL. A survey of fasting during pregnancy. Singapore Med J. 2004;45:583-6.
  3. Rashed AH. The fast of Ramadan. BMJ. 1992. 29;304:521-2.
  4. Car J, Sheikh A. Fasting and asthma: an opportunity for building patient-doctor partnership. Prim Care Respir J. 2004;13:133-5.
  5. Asthma society. Prevalence of asthma in Iran. Tehran University of Medical Science [internet]. 2008 May 8 [sited 2012 August 16]. Available from: http://publicrelations.tums.ac.ir/news/detail.asp?newsID=7151.
  6. Boskabady MH, Kolahdoz GH. Prevalence of asthma symptoms among the adult population in the city of Mashhad (north-east of Iran). Respirology. 2002;7:267-72.
  7. Golshan M, Mohammad-Zadeh Z, Khanlar-Pour A, Iran- Pour R. Prevalence of asthma and related symptoms in junior high school children in Isfahan, Iran. Monaldi Arch Chest Dis. 2002;57:19-24.
  8. Kjeldsen-Kragh J. Rheumatoid arthritis treated with vegetarian diets. Am J Clin Nutr. 1999;70:594S-600S.
  9. Muller H, de Toledo FW, Resch KL. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2001; 30:1-10.
  10. Salti I, Benard E, Detournay B, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004; 27:2306-11.
  11. Sheikh A, Wallia S. [Fasting during Ramadan in diabetes mellitus]. Praxis (Bern 1994) 2008. 14; 97:567-8.
  12. Al SJ, Bener A, Hajar HA. Does hospitalization for congestive heart failure occur more frequently in Ramadan: a population-based study (1991-2001). Int J Cardiol. 2004;96:217-21.
  13. Michalsen A, Weidenhammer W, Melchart D, et al. [Short-term therapeutic fasting in the treatment of chronic pain and fatigue syndromes-well-being and side effects with and without mineral supplements]. Forsch Komplementarmed Klass Naturheilkd. 2002;9:221-7.
  14. Erkekol FO, Celik GE, Keskin O, et al. Fasting: an important issue in asthma management compliance. Ann Allergy Asthma Immunol. 2006;97:370-4.
  15. Abhari A, Majd S. The Opinion of Iranian Asthmatics Regarding the Effect of Food and Diet on Asthma Activity. Chest Meeting Abstracts. 2004;126.
  16. Bener A, Colakoglu B, Mobayed H, El Hakeem A, Al Mulla AA, Sabbah A. Does hospitalization for asthma and allergic diseases occur more frequently in Ramadan fasting: a population based study (2000-2004). Eur Ann Allergy Clin Immunol. 2006;38:109-12.
  17. Siddiqui QA, Sabir S, Subhan MM. The effect of Ramadan fasting on spirometry in healthy subjects. Respirology ,2005;10:525-8.
  18. Subhan MM, Siddiqui QA, Khan MN, Sabir S. Does Ramadan fasting affect expiratory flow rates in healthy subjects?. Saudi Med J. 2006;27:1656-60.
  19. Moosavi SA, Kabir A, Moghimi A, Chehrei A, Rad MB. Evaluation of the effect of Islamic fasting on lung volumes and capacities in the healthy persons. Saudi Med J. 2007;28:1666-70.
  20. Crapo RO. Pulmonary-Function Testing. N Engl J Med. 1994; 331:25-30.
  21. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004 May;59(5):469-7
  22. Asthma control test. [internet].  2012 August 16. Available from: http://www.asthmacontroltest.com.
  23. Jindal SK, Aggarwal AN, Gupta D. Diurnal variability of peak expiratory flow. J Asthma. 2002 Aug; 39:363-73.
  24. Boulet LP. Influence of obesity on the prevalence and clinical features of asthma. Clin Invest Med. 2008 Dec 1;31(6): E386-90.
  25. Hajek P, Myers K, Dhanji AR, West O, McRobbie H. Weight change during and after Ramadan fasting. J Public Health (Oxf). 2011 Nov 13. [Epub ahead of print].