Noisy chest secretions towards the end of life
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Noisy chest secretions are common in the last days of life. They are unlikely to cause pain for the patient but they can be distressing for those around them. There are things you can do to help support them.
On this page:
What are noisy chest secretions?
In the last days of a person’s life, secretions (fluid) might build up in the airways as they become too weak to cough and clear them.
This causes a gurgling or rattling sound when the person breathes in and out and is sometimes called 'the death rattle'.
Chest infections and gastric reflux can also cause excess pooling of fluid in the airways.
Supporting patients and those around them
Noisy chest secretions can be distressing for anyone close to the patient. It might be helpful to explain to patients and those important to them that noisy breathing is common at the end of life, so that it’s less alarming if it does happen.
Acknowledge that it can sound upsetting but reassure them that it’s unlikely that they cause the patient any pain.
If those around the patient are upset or distressed, stay with them and try to explain what the cause of the sound is. Reassure them that it’s common, and if it was causing the patient pain, there would normally be other signs of distress, like being agitated or restless.
You could also share our information for carers on changes in breathing towards the end of life.
Acting quickly makes it easier to manage chest secretions. You can help the patient by positioning them in a way that encourages the excess fluid to drain away. Position them on one side with their upper body raised up. You can do this by raising the head of the bed if they have a profiling (hospital) bed, or propping them up on pillows.
If those around the patient are able, they may want to help with positioning them. You should show them how to do this safely.
Read more about caring for patients in the last hours or days of life.
When to ask for help
If the patient appears distressed by their secretions and repositioning isn’t helping, their GP or specialist nurse might prescribe medications to help.
Antimuscarinic medications, such as hyoscine butylbromide, hyoscine hydrobromide and glycopyrronium may be prescribed. These work by reducing saliva production so they can dry out the secretions. These would normally be given through a syringe driver. They may also be given as required as a tablet or by subcutaneous injection.
It is important to tell those around the patient that it is not always possible to control chest secretions completely.
Useful resources
NICE Clinical Knowledge Summary: Palliative Care - secretions
Key points
- Noisy chest secretions are caused by fluid in the airways.
- They are unlikely to cause pain for the patient but can be distressing for those around them.
- Reassure the patient and those around them that it’s not unusual.
- You can help by positioning the patient in a way that helps the fluid to drain away.
- Ask for help from the GP or specialist nurse if the secretions are distressing for the patient.
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Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
