Live Your Life to Benefit Others
In the name of Allāh, Most Gracious, Most Mercifulبِسۡمِ اللهِ الرَّحۡمٰنِ الرَّحِيۡمِ
DOES THE USE OF AN INHALER BREAK THE FAST
There are many types of devices used by patients with respiratory problems such as asthma, COPD, emphysema, bronchitis, bronchiectasis, cystic fibrosis etc. to deliver medication to the lungs by inhalation. The rulings below apply to all kinds of inhalers (aerosol inhalers, metered dose inhalers, dry powder inhalers) and spacers but not nebulisers.
The jurists (fuqaha) have two rulings on this issue as detailed below.
General Principle of invalidating a fast
If an “agent of consequence” reaches a “cavity of consequence” (jawf) and attains independent stay within the cavity of consequence via an “orifice of consequence” and with the absence of an excuse (e.g. forgetfulness) then the fast is invalidated.
All the above 5 criteria must be fulfilled for the fast to be invalidated according to the Ḥanafiyyah who also restrict the definition of jawf to the stomach. Note also that the orifice of consequence must be connected to the cavity of consequence via a passage (manfadh) directly or via another cavity.
Fiqh Issues Related to The Use of Inhalers
The contemporary Muslims jurists consider the three following classical examples in this case when deriving at their ruling:
1. Inhaling water vapour from food or inhaling smoke from incense
According to the Ḥanafiyyah, Mālikiyyah, Ḥanābilah intentionally breathing in water vapour or smoke breaks the fast.
According to the Shāfi'iyyah ingestion of water vapour or smoke does not break the fast.
2. Ingestion of medication via the mouth
According to all the 4 Sunni madhāhib intentional ingestion of medication breaks the fast.
3. Mouth gargling (during wuḍūʾ) and swallowing the residue while fasting.
All the 4 Sunni madhāhib agree that swallowing of the residual water after gargling comes under the ruling of something that is overlooked.
Ruling 1. Inhalers Break the Fast
Those jurists who opine that the use of an inhaler breaks the fast apply the fiqhi principle that if a fasting person intentionally breathes in (drawing the substance to himself) a substance that has a perceptible body, such as smoke, water vapour, aerosol or similar then the fast is invalidated because an invalidating substance reaches an invalidating cavity via an invalidating orifice (mouth and nose).
Ruling 1 is the one adopted by the Ḥanafī jurists.
Since a fasting person will only use his inhaler when he really needs it, potentially a lifesaver, the Ḥanafī jurists have opined that no expiation (kaffāra) is necessary for breaking the fast during Ramaḍān, the person only has to make up for the broken fast (qaḍā').
Ruling 2. Inhalers Do Not Break the Fast
The arguments put forward by those jurists who opine the fast is not broken includes the following points:
Points 1 Using an inhaler is not considered as a form of eating or drinking.
Counter argument: What is important is not whether the inhaler is considered to be a form of eating or drinking but rather if anything has intentionally been taken in to the stomach.
Reply: Not everything that enters the stomach breaks the fast. For instance, water left in the mouth after rising is overlooked.
Point 2 It is unanimously agreed upon by the jurists that a fasting person can rinse his mouth and nose, and when he does so, traces of water will remain in the mouth which will reach the throat which is a passage to the stomach. In a similar manner, very small amounts of the medication will reach the throat and perhaps stomach via the use of an inhaler, however, because the amount is so small it takes the same ruling as the water that remains in the mouth after rinsing of the mouth.
Counter argument: This analogy is not valid. The intended destination of the water during gargling is the mouth whereas the intended destination of the inhaler is beyond the mouth, it reaches the throat which is a passage to the stomach.
Reply: The intended destination of the inhaler is not the stomach it is the lungs and what breaks the fast is if something reaches the stomach and not the throat in itself.
Counter argument: The residual water in the mouth after gargling is not something that can be avoided whereas the use of the inhaler can be.
Point 3 All the jurists agree that the use of a dry miswāk during fasting up to midday does not invalidate the fast. Ḥanafī jurists allow its use all day even if it is wet. It is known that miswāk contains several chemicals and it is likely that tiny amounts of these chemicals will reach the throat which is a passage to the stomach but these tiny amounts are overlooked, the same ruling is applied to the tiny amount of medication that reaches the throat and stomach via the use of an inhaler.
Point 4 The particles from the inhaler reach the throat but there is no certainty that any particles will reach the stomach to invalidate the fast. The legal maxim that certainty is not diminished by doubt is applied. So a person in a state of fasting will remain in that state until there is evidence to the contrary.
Counter argument: It is known that only about 10% of the medication reaches the lungs according to some studies (40% at best) so some medication must reach the stomach. When an aerosol inhaler (metered dose inhaler) is used alone most the medication can end up in the mouth, throat and stomach.
Reply: The amount reaching the stomach is of a similar magnitude to the water that reaches the stomach after gargling so can be overlooked. The dose of a typical Salbutamol inhaler is only 200-400 micrograms (2 puffs) which is a very small dose. With dry-powder inhalers the amount of medication reaching the stomach will be extremely small.
Ruling 2, that the use of an inhaler does not invalidtae the fast, is the stand of many jurists including Sheikh `Abdul-`Aziz bin Abdullah ibn Baz, Sheikh Abu 'AbdAllah Muhammad ibn Saalih Al `Uthaymeen and Sheikh `Abdullah ibn Jibrin, it is also the stand of the Saudi Permanent Committee for Fatāwa. The majority opinion of the scholars at the 9th Fiqh-medical seminar, 1997, was that inhalers do not break the fast.