Eye Drops, Inhalers and Nasal Sprays in Ramzan: The Facts

If you have asthma and your chest tightens during a fast, use your reliever inhaler. Straight away, every time. An attack can turn dangerous within minutes, and no fast is worth that. Whether an inhaler, eye drop or nasal spray affects the roza is a question for your scholar; when you use it is a question for your doctor. Here are the medical facts both of them will want you to know.

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Every Ramzan, some people with asthma quietly skip their preventer for a month, and some glaucoma patients stop their eye drops “just until Eid”. Both can go badly. The skipped preventer lets the airways turn swollen and twitchy again, so that by the third week a whiff of frying smoke brings on a big attack, while stopped glaucoma drops let eye pressure creep up without a flicker of pain. This guide, from our Ramzan Health series, explains how each of these medicines works and what questions to take to your doctor and your scholar.

Inhalers: how they work, and why the reliever never waits

Picture your airways as soft tubes wrapped in tiny muscles, and in asthma the lining is sore and swollen, so the muscles squeeze whenever something irritates them, whether dust, smoke from the pakora pan, cold air or a hard cough. The tube narrows. That’s the wheeze.

• The reliever (usually a blue inhaler, salbutamol) relaxes that squeezing muscle within minutes. It’s the rescue.
• The preventer (usually a steroid inhaler, often brown, orange or purple, sometimes combined with a long-acting reliever) calms the swollen lining over days and weeks. It works only if taken regularly.

An inhaler puts a fine mist into the lungs, some of which lands in the mouth and throat, and that’s the part people worry about for the fast, which your scholar can guide you on. Medically, what matters is this: in an attack, you use the reliever. Breathlessness that makes it hard to speak, lips turning blue, or a reliever that isn’t helping are emergency signs, and the fast ends there.

Preventers in Ramzan: questions for your doctor

Many preventers are taken morning and evening, which can line up with sehri and iftar. Some come as once-daily versions. Whether a switch or a new time suits you depends on how controlled your asthma is, and only your doctor can judge that. Take these questions along:

1. Can my preventer be taken at sehri and after iftar, and is my current one suitable for that?
2. What do I do if I need my reliever more than usual during the month?
3. Is my asthma controlled well enough to fast at all this year?
4. Should I rinse my mouth and gargle after the preventer at sehri, and is that fine to do before dawn? (Rinsing helps stop mouth thrush from steroid inhalers.)
5. Does my spacer technique need checking? A spacer puts more into the lungs and less in the mouth.

For more on the difference between devices, see Nebulizer vs Inhaler With Spacer vs Steam Inhaler. If family keeps saying inhalers are “addictive”, our piece on the inhaler addiction myth explains why that’s wrong.

Eye drops: why you can taste them, and a simple trick

Your eye has a tiny drain at the inner corner, near the nose, and tears and eye drops flow down that channel into the nose and the back of the throat, which is why a bitter drop in the eye can reach your tongue a minute later. Odd, but normal.

Pressing gently on that inner corner closes the drain for a moment, a trick called punctal occlusion that eye doctors teach all year round anyway, because it keeps more of each drop in the eye where it’s needed and lets less of it wander into the rest of the body. Here’s how:

1. Wash your hands. Tilt your head back and pull the lower lid down.
2. Put in one drop. Don’t let the bottle touch the eye.
3. Close the eye gently. Don’t squeeze or blink hard.
4. Press a fingertip lightly on the inner corner, beside the nose, for about 1 to 2 minutes.
5. Wipe away any extra with a clean tissue. If you use two kinds of drops, leave about 5 minutes between them.

Glaucoma drops deserve a special word. Glaucoma raises eye pressure silently and damages the nerve that carries sight from the eye to the brain, the loss it causes never comes back, and the drops that hold it off are usually on a fixed timetable. Ask your eye doctor whether the times can shift to sehri and after iftar; don’t just drop the midday dose. Lubricating drops (artificial tears) for dry eyes are usually easier to move around. Ask about the fast from your scholar.

Nasal sprays and saline

A nose spray lands on the lining inside the nose, and some trickles to the throat. Three common kinds:

• Salt water (saline) sprays and rinses, which just clean and moisten.
• Steroid nose sprays for allergies (nazla that keeps coming back), which work slowly over days and are often taken once or twice daily at a set time.
• Decongestant sprays that open a blocked nose fast. These shouldn’t be used for more than a few days in a row, fasting or not, because the blockage rebounds.

Many steroid sprays can sit at sehri or iftar time, but ask your doctor first, and when you do spray, tilting your head slightly forward and aiming the nozzle outwards towards the ear on the same side keeps more of the dose in the nose and sends less down the throat. Small trick. Big difference.

Myth: it’s better to stop your medicines for Ramzan and restart after Eid

This is the risky one. Asthma preventers, glaucoma drops and allergy sprays all work by keeping a problem quiet every single day, so if you stop them the problem returns, often worse than before and often at the least convenient moment, like the night of the 27th. Many medicines can be re-timed to fit a fast, and that’s exactly the conversation to have with your doctor before the month starts. Religious concessions for the ill exist, and your scholar can explain how they apply to you.

Did you know? Ear drops, when the eardrum is intact, sit in the ear canal and don’t pass into the throat. A burst eardrum changes that, which is one more reason never to put anything in an ear that’s leaking or painful without a doctor’s check.

Questions people ask about inhalers and drops in Ramadan