The dying patient — In the last hours and days of life, cough can affect up to 80 percent of patients; contributory factors are asthenia, muscle weakness, and increased respiratory secretions.
A cough is common symptom if you have a terminal illness, especially if it is related to a lung disorder such as lung cancer. A cough can be caused by the terminal illness itself or by any pre-existing lung conditions you may have, such as COPD or interstitial lung disease.
In the last days of a person's life, secretions (fluid) might build up in the airways as they become too weak to cough and clear them. This causes a gurgling or rattling sound when the person breathes in and out and is sometimes called 'the death rattle'.
Cough in palliative care patients is often associated with infection (acute and chronic), aspiration, gastroesophageal reflux, pleural effusion, or the direct effects of malignancy on the lung or airways.
How Long Does the Active Stage of Dying Last? The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage.
The patient's bowel movements may stop entirely, or they may become incontinent. Their breathing may become shallow and irregular, with long pauses that grow frequent as death approaches. There may also be sounds of chest congestion and throat rattling in the last hours.
Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears.
Managing symptomatic cough in palliative care can be done by a stepwise approach: Simple measures, such as humidified room air or simple linctus. A weak opioid cough suppressant, such as codeine linctus. A strong opioid cough suppressant, such as morphine.
Terminal respiratory secretions, commonly known as a “death rattle,” occur when mucous and saliva build up in the patient's throat. As the patient becomes weaker and/or loses consciousness, they can lose the ability to clear their throat or swallow.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
Agonal Breathing
This means the breathing pattern is reflexive, and no longer a response to conscious awareness. Agonal gasping at the end of life is not a “desire or hunger for air” but rather a basic reflex of the dying brain.
The sound varies. It may be a crackling, wet noise that is amplified as the person breathes. In other cases, it may sound like a soft moaning with each breath, or a very loud gurgling or snoring. While the sound may be unpleasant, the person emitting the death rattle usually feels no pain or discomfort.
The body naturally produces mucus in your breathing system, including the lungs and nasal passages. When you're healthy, this mucus is removed through coughing. When you're dying and no longer moving around, the mucus can build up and cause a rattling sound when you breathe.
Palliative care is about living in a way that is meaningful to you, within the limits of your illness. It's not simply about dying. Some people live comfortably for months or years after a diagnosis of advanced cancer, and can be supported by palliative care as needed.
No, palliative care does not mean death. However, palliative care does serve many people with life-threatening or terminal illnesses. But, palliative care also helps patients stay on track with their health care goals.
A dying person's breathing will change from a normal rate and rhythm to a new pattern, where you may observe several rapid breaths followed by a period of no breathing (apnea). These periods of apnea will eventually increase from a few seconds to more extended periods during which no breath is taken.
As a patient nears death, it is common for their breathing patterns to change. These end-of-life breathing patterns can happen very quickly, or it can occur over many hours or even days. This is a normal part of the dying process as the body begins to slowly shut down.
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
Their mouth may fall open slightly, as the jaw relaxes. Their body may release any waste matter in their bladder or rectum. The skin turns pale and waxen as the blood settles.
Palliative care is available when you first learn you have a life-limiting (terminal) illness. You might be able to receive palliative care while you are still receiving other therapies to treat your condition. End of life care is a form of palliative care you receive when you're close to the end of life.
Death rattle usually becomes audible 24 to 48 hours before death (6,7). Reducing the distress among listeners has been conventionally treated through attempts to reduce or eliminate patient noise.
Your hospice team's goal is to help prepare you for some of the things that might occur close to the time of death of your loved one. We can never predict exactly when a terminally ill person will die. But we know when the time is getting close, by a combination of signs and symptoms.