Navigating the end-of-life journey for a loved one is a sensitive experience, often accompanied by physical changes unsettling for families and caregivers. The accumulation of secretions in the airways can produce sounds distressing to hear. This article explains why these secretions occur and how they can be managed for comfort. Understanding these processes can alleviate anxiety and promote a peaceful environment.
Why Secretions Occur
As an individual approaches the end of life, body functions slow. This includes a decline in managing continuously produced saliva and mucus. Normally, these fluids are cleared by swallowing or coughing. However, with diminishing energy and consciousness, these reflexes become less efficient or are lost.
Pooling secretions in the throat and upper airways can cause a gurgling or rattling sound with each breath, often called the “death rattle.” This sound occurs as air passes over accumulated fluids, creating vibrations. While this noise can be upsetting, it typically does not indicate pain or discomfort for the dying person, whose awareness and sensation are often diminished.
Several factors contribute to secretion accumulation. Weakening swallowing muscles (dysphagia) is common as neurological and physical capabilities decline. A reduced or absent cough reflex also prevents mucus clearance from respiratory passages. This natural physiological progression is part of the body’s shutting down process.
Medications Used to Manage Secretions
Specific medications are used to manage secretions and reduce distressing sounds. These are primarily anticholinergics. They work by blocking acetylcholine, a neurotransmitter involved in saliva and mucus production. By inhibiting these processes, anticholinergics reduce secretion volume.
Common anticholinergics include glycopyrrolate, scopolamine (hyoscine), and atropine. Glycopyrrolate acts on the peripheral nervous system, affecting glands that produce secretions without significantly crossing the blood-brain barrier. This localized action minimizes central nervous system side effects like sedation. It reduces saliva and respiratory tract secretions, alleviating gurgling sounds.
Scopolamine (hyoscine) is another effective anticholinergic. It reduces fluid production from glands throughout the body, including those in the mouth and respiratory passages. Scopolamine is useful as it also has sedative properties, contributing to overall comfort. Atropine is also an anticholinergic used to dry secretions by reducing glandular output.
The goal is to decrease new secretion production, rather than eliminate existing ones. They dry mucous membranes, making it more difficult for fluids to accumulate and create sounds. Medication choice depends on patient needs and healthcare team preferences.
What to Expect After Medication Administration
After medication administration for secretion management, families and caregivers can anticipate changes. These anticholinergics are typically given subcutaneously (under the skin) or sublingually (under the tongue) for quick absorption. Onset of action varies, but effects are often noticeable within 15 to 30 minutes for subcutaneous or sublingual routes, with peak effect usually within an hour or two.
It is important to manage expectations regarding medication outcomes. While effective at reducing new secretion production, they do not eliminate accumulated secretions. Therefore, some gurgling sounds may persist, but their intensity is often lessened, and fluid volume may decrease. The primary aim is to enhance comfort and reduce sounds distressing to loved ones.
Mild side effects can occur due to the medications’ drying action. A common effect is dry mouth, part of the intended mechanism. Increased thirst may also be noted if the individual is conscious and able to communicate. Some might experience slight sedation, particularly with scopolamine, which can contribute to a more peaceful state. These effects are generally acceptable given the goal of symptom management and comfort.
Broader Comfort Care and Support
Beyond medication, non-pharmacological comfort measures can help manage secretions and provide support. Repositioning the individual, such as gently turning them onto their side, can encourage secretions to drain naturally. Elevating the head slightly can also assist in clearing airways and reduce fluid pooling.
Maintaining good oral hygiene is also important. Gently wiping away visible secretions around the mouth with a soft cloth or swab can keep the area clean and moist. While fluids may be difficult to swallow, offering small sips of water or ice chips, if appropriate, can provide hydration and comfort to dry lips and mouth.
Hospice or palliative care teams provide invaluable comprehensive support. These teams offer holistic care addressing physical symptoms, emotional, and spiritual needs for the patient and family. They provide guidance on medication administration, practical comfort tips, and answer questions about the dying process. Their presence ensures comfort is prioritized and families feel supported throughout the end-of-life journey.