Problems related to respiratory secretions can be caused by infection or aspiration, or by pooling of normal oropharyngeal secretions in a patient who is weak or unable to swallow or cough effectively (for instance in motor neurone disease) or who has a reduced state of consciousness. The latter situation is common as death approaches ('death rattle'). Pulmonary oedema also causes increased respiratory secretions.
There is currently no evidence to show that medications for treating respiratory secretions at the end-of-life are more effective than placebo, although the evidence base is extremely small. [1-3] In the absence of evidence to guide recommendations there is some uncertainty as to the need to treat secretions. However, it is recognised that noisy breathing can be distressing to carers and family and therefore it may be necessary to initiate treatment based on individual needs.