These are common in the last days of life, but are generally more troubling for family members than for the patient themselves.

Management

Conservative:

• Avoiding fluid overload - particularly stopping IV or subcutaneous fluids
• Educating the family that the patient is likely not troubled by secretions

Medical:

• hyoscine hydrobromide or hyoscine butylbromide is generally used first-line
  • neither the BNF nor NICE Clinical Knowledge Summaries suggest one is first-line over the other
  • hyoscine butylbromide may be less sedative than hyoscine hydrobromide
• glycopyrronium bromide may also be used