Clinical factors influencing death rattle breathing in palliative care cancer patients : Non-interventional study

In the last days of life the clinical symptom of death rattle breathing is manifested in many awake or semiconscious patients in palliative care. Scientific studies on relevant influencing factors on the characteristics of the clinical symptom of death rattle breathing in patients in palliative care are rare.

The design of the study is based on a non-interventional prospective study with questionnaire evaluation and was implemented at the palliative care unit at the Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care at the Clinical Center Klagenfurt, Austria. The questionnaire was developed by the authors of this study.

The study had a predefined duration of 10 months (from February to November 2012) and during this period a total of 273 patients were admitted to the palliative care unit of the Clinical Center in Klagenfurt. Of these 105 (38.5 %) died and could therefore be included in the evaluation but 3 patients in palliative care (2.9 %) did not fulfil the inclusion criteria of a malignant disease. In total 102 patients, 43 females (42.2 %) and 59 males (57.9 %) were evaluated. The average age was 69 years with a range of 41-92 years. The largest proportion of the random sample (62.8 %) was in the patient age group from 61 to 80 years old and death rattle breathing could be observed in 26 patients (25.3 %) of the total sample. In a specific subgroup analysis regarding the intensity of the symptom, many of the affected patients suffered noisy breathing or severe death rattle breathing. In these cases it was primarily women in the group of patients with death rattle breathing. Gender was found to be a statistically relevant influencing factor (p = 0.034) on the intensity of the symptom.

The great majority of the variables studied showed no influence on the development of the symptom of death rattle breathing; however, more intensive forms were manifested in female patients. The small study population could be a limitation of the present study although the prospective design allows valid conclusions to be drawn. In the future studies should be implemented in order to improve treatment of patients suffering from death rattle breathing.