M42 Ramadan fasting for patients with chronic respiratory diseases: a systematic review and consensus recommendations for healthcare professionals

<h3>Background</h3> Ramadan, observed by nearly two billion Muslims worldwide, involves fasting from dawn to sunset, presenting challenges for individuals with chronic respiratory diseases due to potential risks from altered medication regimens and oral intake restrictions. This study aimed to synthesise the current evidence to develop consensus recommendations for managing patients with asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and bronchiectasis during Ramadan. <h3>Methods</h3> A comprehensive search of electronic databases was conducted including MEDLINE, EMBASE and Google Scholar, according to a pre-specified protocol (PROSPERO CRD42024532759) to identify studies on the outcomes of Ramadan fasting in individuals with chronic respiratory diseases. The findings informed consensus recommendations stratified by the risk of adverse outcomes using the IDF-DAR risk assessment criteria. An international expert group including both medical and religious experts, was convened to refine these guidelines, achieving consensus approval from all authors. <h3>Results</h3> 11 studies met the inclusion criteria, primarily addressing asthma and COPD, with no relevant studies found on ILD or bronchiectasis. The studies revealed that fasting did not significantly impact hospitalisation rates or lung function tests in individuals with stable asthma and COPD. However, the studies were limited by small sample sizes and methodological limitations, limiting the generalisability of findings. To develop the consensus recommendations, a multinational panel of 12 reviewers was assembled, comprising both muslim and non-muslim experts. The panel included respiratory physicians, general practitioners, and religious scholars, ensuring recommendations were both religiously sensitive and medically robust. 19 recommendations were developed to support patients considering fasting, emphasising pre-Ramadan consultations, individualised risk assessments, and adjustments to medication regimens to accommodate fasting hours. <h3>Conclusion</h3> This systematic review highlights the need for larger, well-designed, studies to better understand the implications of Ramadan fasting across chronic respiratory diseases, particularly ILD and bronchiectasis. The developed recommendations offer a structured approach to assess the risks associated with fasting, ensuring healthcare providers can offer informed and safe guidance during Ramadan. These recommendations should be applied with consideration of individual clinical judgement and patient preferences. Future research should aim to fill the gaps identified, supporting evidence-based guidelines that reconcile medical and religious considerations.