Anticholinergic drug regimens for respiratory tract secretions in the last days of life

Anticholinergic drugs may be more effective in decreasing the intensity of noisy rattly breathing when administered regularly, than when administered as required. If an anticholinergic drug is used, it should be given as soon as the rattle begins, because anticholinergics reduce the production of new secretions but do not affect existing secretions. There is no evidence to support the use of one anticholinergic over anotherLokker, 2014Wildiers, 2009. However, glycopyrronium or hyoscine butylbromide is preferred because these drugs are unlikely to cause or exacerbate delirium as they do not readily cross the blood–brain barrier. If glycopyrronium or hyoscine butylbromide are not available, seek specialist palliative care advice.

When using an anticholinergic drug, follow the principles of drug therapy for symptoms in the last days of life, and consider stopping therapy if there is no improvement after 24 hoursWildiers, 2009.