- Can be a symptom in advanced respiratory disease, head and neck cancers, and neuro-degenerative disorders.
- In people who are dying, this may be part of the terminal process known as “Death Rattle”.
- Explanation and reassurance for the patient and family is very helpful.
- Deep suctioning should be avoided as this increases mucous production and is unpleasant for the patient but Oral suctioning with yanker suction can sometimes be helpful.
- Re-positioning is often helpful.
- Attention to oral hygiene is essential – see section on Dry Mouth.
- Drug therapy may be indicated but drying of secretions is not always the most appropriate initial management. Drying of secretions may make it more difficult for patients to bring up sputum in those still able to cough.
When considering the appropriate drug therapy, note the following:
- Hyoscine butylbromide (BuscopanTM) is preferred because it does not cross the blood-brain barrier and therefore causes less sedation and confusion than Hyoscine hydrobromide and Scopoderm TTSTM.
- Atropine is excitatory and should be avoided.
One of the following agents can be helpful. Do not use concurrently:
- Hyoscine butylbromide (Buscopan™)
- 10 - 20 mg subcutaneous 6 hourly.
- 40 - 120 mg/24 hours subcutaneous infusion.
- Recommended for use in patients where avoidance of sedation is preferred.
- Scopoderm TTS™ (Hyoscine)
- Apply patch every 3 days.
- Needs to be applied early to be effective.
- Available by special authority - See PHARMAC website or check with the hospital pharmacist (often supply problems due to availability).
- More potent than hyoscine and better side effect profile.
- 0.2 mg subcutaneously stat.
- 0.2 - 0.6 mg/24 hours subcutaneous infusion.
See Kintzel PE, Chase SL, Thomas W, Vancamp DM, Clements EA. "Anticholinergic medications for managing noisy respirations in adult hospice patients". Am J Health Syst Pharm. 2009 Mar 1;66(5):458-64.
Topic Code: 4120