Respiratory Secretions
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Respiratory Secretions

Noisy breathing due to respiratory secretions is a common sign that a person is approaching the final stage of life. This occurs when saliva and mucus build up in the throat because the person is too weak to clear them. The sound may be wet, gurgling, or rattling, which can be distressing for families, but it does not mean the person is in pain or struggling to breathe. Reassuring families and providing gentle care is key, as this is a natural part of the dying process.

What I can do

Provide comfort to the older person by:

  • Repositioning them on their side to help secretions drain naturally
  • Elevating the head slightly to clear the airways
  • Gently wiping away any secretions around the mouth.

Reassure the family that:

  • Noisy breathing is a normal part of the dying process
  • The older person is not in any pain or distress and may be unaware of the symptom
  • They can help by holding the person’s hand and speaking to them, even if they are unresponsive.

Although treatments are available, they are often unhelpful in most cases. For example:

  • Anticholinergic medications, such as hyoscine butylbromide, can reduce the body’s fluid production but have side effects and may not work for everyone
  • Suctioning can remove excess secretions but should be done sparingly as it can cause discomfort and may increase secretions.
Tips for Careworkers: Respiratory secretions
 
Tips for Nurses: Respiratory secretions

What I can learn

The palliAGED Practice Tips give helpful guidance on understanding and managing respiratory secretions at the end of life. There is a version for nurses as well as one for careworkers.

Explore the current research evidence on this topic by reading the CareSearch Respiratory secretions Clinical Evidence Summary.

Prescribers can find advice on managing anxiety and agitation with medication in the CareSearchgp and palliMEDs apps.

CareSearchgp app

What I can give

If an older person, their family or carer is concerned about respiratory secretions, these resources may help:

What I can suggest

Provide training to staff on:

  • Recognising respiratory secretions and understanding the implications for care
  • Repositioning and other non-drug comfort measures
  • Communicating with families about what is happening.

Establish clear protocols and guidelines for managing secretions that align with best palliative care practice.

Ensure ready access to anticipatory medications and guidance on their use in the terminal phase.


Page updated 26 February 2025