As a person nears the end of life, families and caregivers may notice changes in breathing, including noisy respiratory secretions. These sounds can raise questions and be a source of concern for those present. Understanding them is important for providing support and comfort. This article clarifies what these secretions are, why they occur, and how they relate to the dying person’s experience.
What Are “Secretions When Dying”?
Noisy respiratory secretions at the end of life, often called the “death rattle,” are wet, gurgling, or rattling sounds. These sounds occur as a person breathes, caused by the accumulation of saliva and mucus in the throat and upper airways. They can resemble gentle bubbling or crackling, and their volume may vary.
The “death rattle” refers to noisy breathing from throat and chest secretions in the final stages of life. These secretions are categorized into two types: oral secretions, which are softer gurgling sounds from saliva and mucus in the upper throat and mouth, and bronchial secretions, which produce a deeper, louder rattling sound from mucus in the lower airways. Both types result from the body’s weakening ability to manage secretions.
Why Do These Secretions Occur?
Noisy secretions occur as the body’s natural processes slow down near death. A person may become too weak or lose consciousness, impairing their ability to effectively clear their throat or swallow. This means they can no longer cough or swallow to remove saliva and mucus, leading to fluid accumulation.
The diminished cough reflex and altered consciousness contribute to this reduced ability to manage secretions. Air passing over these pooled fluids creates the characteristic gurgling or rattling sound. This phenomenon is a natural part of the dying process, as the body conserves energy and many organ functions slow or cease.
Understanding the Dying Person’s Experience
A primary concern for observers of noisy breathing is whether the dying person experiences pain or distress. Evidence suggests the individual is typically not conscious of the sounds and does not experience discomfort or choking. Their level of consciousness in a person nearing death is often significantly diminished, meaning they are unaware of the secretions.
While the sound can be distressing for family members and caregivers, it does not indicate suffering or struggling to breathe. The sound is a byproduct of the body’s natural decline. The dying person is often deeply unconscious or semi-comatose, and their perception of discomfort is greatly reduced. The unsettling nature of these sounds is usually more impactful for observers than for the person experiencing them.
Comfort Measures and Management
Providing comfort for a person experiencing noisy secretions primarily focuses on easing caregiver concerns and ensuring the individual’s dignity. Non-pharmacological interventions are often the first approach. Repositioning the person, such as turning them on their side with their head slightly elevated, can encourage secretions to drain and minimize the sound.
Maintaining good oral hygiene, including gently swabbing secretions that accumulate in the mouth, can also contribute to comfort. Limiting oral fluid intake may be considered. For caregivers, playing background music can help mask the sounds, providing relief.
When these measures are insufficient or sounds are distressing to observers, healthcare professionals may consider pharmacological interventions. Anticholinergic medications, such as hyoscine butylbromide or glycopyrronium, can reduce the production of new secretions. These medications do not remove existing secretions but help dry up future ones. Discuss these options with a healthcare team to determine the most suitable approach for the individual’s specific situation.