Secretions at the end of life: Information for clinicians

This information is sourced from Dr Ros Taylor a senior palliative physician

Q. How should I treat noisy breathing at the end of life?

Approximately 1/3 of patients who are imminently dying may develop rattly breathing.

This sound is caused by air moving through secretions in the upper airway. These secretions are not swallowed due to decreased consciousness in the final hours and days of life.

It rarely causes distress to the patient but can be very distressing for relatives.

Suction and oxygen is rarely required and can be intrusive at this stage of life. Repositioning patients may help.

Treatment 

Approximately 1/3 of patients who are imminently dying may develop rattly breathing.

This sound is caused by air moving through secretions in the upper airway. These secretions are not swallowed due to decreased consciousness in the final hours and days of life.

It rarely causes distress to the patient but can be very distressing for relatives.

Suction and oxygen is rarely required and can be intrusive at this stage of life. Repositioning patients may help

Options to avoid injections

Kwells 300mcg tablets (hyoscine hydrobromide) - dissolve on tongue - use up to 3 x daily - can be purchased over the counter.

Scopoderm 1.5mg patches (hyoscine hydrobromide) every 72 hours may help if started before secretions accumulate.

Atropine 1% eye drops 4 drops can be used on the tongue every 4 hours.

Patients don't require any treatment if families are at ease with this symptom as it is often a natural part of dying, and some feel that treating these secretion may prolong the dying phase.

Dr Kathryn Mannix has produced a 3 minute video explaining the process of ordinary dying including noisy breathing at the end of life which you can share with families or carers.

Recommended Resources

JAMA: Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of Life

Published 5th October 2021

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St Luke's Hospice Community Service
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St Luke's Hospice community service provides assessment, support advice and care for people wishing to be cared  and supported in their locality community setting. The team also provide support in care homes, the hospice's rapid access service and there is the provision of clinical nurse specialists.

St Luke's Hospice In Patient Unit
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St Luke's Hospice provide specialist in-patient care for symptom management and end of life care.        

There are a total of 7 beds and 1 emergency bed in Basildon.

Hospice Rapid Access Service (HRAS) with 6 Beds in Thurrock.

St Luke's Hospice Physiotherapy Support
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St Luke's Hospice Physiotherapy team can help when living with a life limiting illness.  Specialist Physiotherapists and Occupational Therapists will listen and assess to support independence and aid mobility to manage symptoms and positively impact quality of life and wellbeing.

Family and loved ones are also supported in their caring roles. Advice, guidance and techniques on how to safely move and handle someone when caring for them can be accessed through conversation with the Physiotherapy team.

The offer includes:

  • individual assessments to help provide appropriate equipment, e.g. mobility aids
  • personalised treatment plans including non-drug pain relief treatments and exercises to improve mobility, independence and balance
  • treatments to assist with shortness of breath, fatigue or insomnia
  • group exercise classes and confidence building

Rehabilitative care is also provided by our Occupational Therapy team. 

St Luke's Hospice Pre & Post Bereavement Support
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St Luke's Hospice Pre & Post Bereavement Support

T. 01268 526259

W. https://www.stlukeshospice.com/bereavement-support

The Dove Community Counselling Service team at St Luke's Hospice offer bereavement support to adults living with a life limiting illness, from diagnosis through to end of life or into survivorship. 

Bereavement support is also available to those who may have experienced a bereavement from suicide, sudden, traumatic or accidental deaths, or within the last 5 years due to a life limiting illness.

St Luke's Hospice South Essex Lymphoedema Service (SELS)
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St Luke's Hospice South Essex Lymphoedema Service (SELS)

T. 01268 524973

W. https://www.stlukeshospice.com/lymphoedema-support

St Luke's Hospice provides the specialist Lymphoedema care team could provide care to you if you are living with primary Lymphoedema, secondary Lymphoedema and Lipoedema. The team can provide clinical expertise, support and practical help for those with any these conditions and live across South Essex.

Tissue Viability Service: North East London Foundation Trust
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Tissue Viability Service: North East London Foundation Trust

T. 0300 300 1831 ext. 52798

This service is for any persons over the age of 18 and supports the management of complex wound care, via clinic based appointments, or homevisits depending on the need of the service user.

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