title: A retrospective analysis of primary diagnosis, comorbidities, anticholinergic load, and other factors on treatment for noisy respiratory secretions at the end of life.
abstract: BACKGROUND
  Noisy respiratory secretions (NRS) at the end of life have been described in 23%-92% of deaths in palliative care units. Despite limited evidence to support the efficacy of the antisecretory medications, hyoscine hydrobromide and glycopyrrolate, administration of these medications remains standard palliation. Predicting those at risk of NRS could allow early and targeted intervention.
  
  
  METHODS
  A retrospective analysis of 199 deaths in a palliative care unit was undertaken to identify if any patient, disease, or treatment-related factors might be predictive or protective of the symptom.
  
  
  RESULTS
  In the last 72 hours of life, 60% received antisecretory medication (mean, 2; range, 0-16 doses). Significant unadjusted associations were found between administration of antisecretory medications and survival as well as the anticholinergic drug load from other medications. Results obtained from logistic regressions revealed patients with a higher anticholinergic load from prescribed medications were more likely to require treatment for NRS (odds ratio [OR]=2.9, 95% confidence interval [CI]=1.4-5.7). There were no other factors significantly associated with developing the symptom.
  
  
  CONCLUSIONS
  A high anticholinergic load from medications was not protective and instead predicted the need for treatment for NRS at the end of life.
authors: The Cunningham Centre for Palliative Care, Darlinghurst, New South Wales, Australia. csheehan@stvincents.com.au
authors: Caitlin
authors: C
authors: Sheehan
authors: Katherine
authors: K
authors: Clark
authors: Lawrence
authors: L
authors: Lam
authors: Richard
authors: R
authors: Chye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012634:Bodily Secretions / Q000187:drug effects; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D012135:Respiratory Sounds / Q000187:drug effects / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D019452:Terminally Ill
chemical_list: D018680:Cholinergic Antagonists