Respiratory Secretions in the Dying Phase
Noisy, bubbly breathing may occur in 70% patients in the terminal phase. There is little evidence to support the effectiveness of drug treatment for this symptom. However it is
established clinical practice to use anticholinergic drugs to try to reduce the accumulation of further secretions.
- Explanation and reassurance for relatives and carers is paramount.
- Re-positioning the patient in bed may be very helpful, for example ‘high side lying’ where the patient is positioned more upright with their head tilted to one side to aid drainage of secretions. A fan may also be beneficial.
- On occasion, for example where there is pooling of saliva in the oropharynx, gentle suction may be appropriate.
- Hyoscine butylbromide and glycopyrronium do not usually cause drowsiness, confusion and paradoxical excitation since they do not cross the blood-brain barrier.
Anticholinergic, Subcutaneous Route
STAT/PRN Injection: 20 mg
Syringe Driver/pump over 24 Hours: 60 – 120 mg
STAT/PRN Injection: 200 micrograms
Syringe Driver/pump over 24 Hours: 600 micrograms – 1200 micrograms
(also has sedative properties; may exacerbate confusion)
STAT/PRN Injection: 400 micrograms
Syringe Driver/pump over 24 Hours: 1200 micrograms to 1600 micrograms