Hyoscine vs glycopyrronium for drying respiratory secretions in dying patients

The 'death rattle' is a common symptom among dying people, and causes a great deal of anxiety and upset to relatives and carers, including nurses. A mini-review was carried out to evaluate the effectiveness of two drugs--hyoscine hydrobromide and glycopyrronium--in drying up respiratory secretions in terminally ill patients. Searches were made of the Cochrane Library, Medline, Embase, Cinahl and Pharmline. Reference lists, trial databases and professional colleagues were also consulted. There was a scarcity of research material directly comparing the effects of the two drugs in the clinical setting. Two papers were used for comparison in the review but these produced conflicting results. Many discrepancies existed in terms of research methods, and in results. One paper demonstrated that hyoscine hydrobromide was the more effective drug; the other favoured glycopyrronium. There is no clear evidence to support the choice of one drug over the other, based on the clinical outcome selected for this review. Although clinical trials are difficult to conduct in this vulnerable patient group, more research is needed to facilitate the best management of this distressing symptom and allow clinical guidelines to be produced.