title: Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care.
abstract: The management of 'death rattle' was reviewed by a task group on behalf of the Association for Palliative Medicine's Science Committee. Evidence was searched for the effectiveness of various anti-muscarinic drugs in drying oropharyngeal and bronchial secretions in dying patients. Clinical guidelines were constructed based on evidence from volunteer and clinical studies. Death rattle occurs in half of all dying patients and some response occurs in around 80% of treated patients. Clinical studies demonstrate that subcutaneous hyoscine hydrobromide 400 microg is more effective at improving symptoms at 30 min than glycopyrronium 200 microg by the same route. Volunteer studies demonstrate that intramuscular glycopyrronium 400 microg is as effective in drying secretions at 30 min as a dose of 200 microg given intravenously. Duration of response is shortest for hyoscine butylbromide (1 h) and longest for glycopyrronium (more than 6 h). There is insufficient evidence to support the use of one drug over another in a continuous infusion and prescribers should base decisions on different characteristics of each anti-muscarinic drug.
authors.affiliation: St. Gemma's Hospice, Leeds, UK. m.bennett@st-gemma.co.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Bennett
authors.forename: Viv
authors.initials: V
authors.lastname: Lucas
authors.forename: Mary
authors.initials: M
authors.lastname: Brennan
authors.forename: Andrew
authors.initials: A
authors.lastname: Hughes
authors.forename: Valerie
authors.initials: V
authors.lastname: O'Donnell
authors.forename: Bee
authors.initials: B
authors.lastname: Wee
mesh_terms: D001980:Bronchi / Q000378:metabolism*; D019317:Evidence-Based Medicine; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010166:Palliative Care / Q000379:methods; D012135:Respiratory Sounds / Q000187:drug effects*; D012463:Saliva / Q000378:metabolism*
chemical_list: D018727:Muscarinic Antagonists