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Excessive respiratory secretions are common at the end of life.  It is caused by the pooling of fluids in the hypopharynx and arises from several sources; saliva, respiratory tract infection, pulmonary oedema and gastric reflux. Medication used to control this symptom aims to prevent further accumulation of secretions but does not treat established secretions.

A Cochrane review has shown no good quality evidence for the use of any antisecretory medication and another review in 2014 has repeated this finding.  It is clear, therefore, that further research needs to be done to establish optimum treatment regimes but clinical experience would suggest that with early recognition and a low threshold for treatment, secretions can be minimised. The following recommendations are based on current practice and other clinical guidelines.


The above is an extract from our Antisecretories guideline.

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Antisecretories guideline