Response to “Hyoscine butylbromide for the management of death rattle: sooner rather than later”

We read with interest the article "Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later" by Mercadante et al,(1) comparing pre-emptive hyoscine butylbromide for the management of noisy upper respiratory tract secretions (RTS) in patients in the last days of life with treatment of RTS when they occurred. Previous studies have administered anticholinergic drugs to treat already formed noisy RTS rather than preventing their formation, but anticholinergic drugs are unable to remove secretions already formed.

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