Atropine, hyoscine butylbromide, or scopolamine are equally effective for the treatment of death rattle in terminal care.
Death rattle is a frequent symptom (25%-50%) in the terminal stage of life, but there is neither standardized treatment nor prospective investigation performed on the effectiveness of anticholinergic drugs. The aim of the present study was to investigate the effectiveness of three different anticholinergic drugs in the treatment of death rattle in the terminal stage of life. Terminal patients who developed death rattle were randomly assigned 0.5mg atropine, 20mg hyoscine butylbromide, or 0.25mg scopolamine. Each treatment was initiated with a subcutaneous bolus, which was followed by continuous administration of the same drug. The intensity of death rattle and side effects were prospectively scored at different time points. Three hundred and thirty-three eligible patients were randomized to atropine, hyoscine butylbromide, or scopolamine after informed consent from the patient or the appointed representative. For the three drugs, death rattle decreased to a nondisturbing intensity or disappeared after one hour in 42%, 42%, and 37% of cases, respectively (P=0.72). Further, effectiveness improved over time without significant differences among the treatment groups (effectiveness at 24 hours was 76%, 60%, and 68%, respectively). In an analysis on the three groups together, treatment was more effective when started at a lower initial rattle intensity; median survival after start of therapy was 23.9 hours. These data suggest that there are no significant differences in effectiveness or survival time among atropine, hyoscine butylbromide, and scopolamine in the treatment of death rattle.
Wildiers
Hans
H
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium. hans.wildiers@uzleuven.be
Dhaenekint
Chris
C
Demeulenaere
Peter
P
Clement
Paul M J
PM
Desmet
Mark
M
Van Nuffelen
Rita
R
Gielen
Jacques
J
Van Droogenbroeck
Erna
E
Geurs
Filip
F
Lobelle
Jean-Pierre
JP
Menten
Johan
J
D000368:Aged; D001285:Atropine / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D012634:Bodily Secretions / Q000187:drug effects*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002086:Butylscopolammonium Bromide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010166:Palliative Care / Q000706:statistics & numerical data*; D010276:Parasympatholytics / Q000627:therapeutic use; D012135:Respiratory Sounds / Q000187:drug effects*; D012601:Scopolamine / Q000627:therapeutic use*; D013727:Terminal Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D010276:Parasympatholytics; D002086:Butylscopolammonium Bromide; D001285:Atropine; D012601:Scopolamine