Jump to top menu Jump to main menu Jump to content
default image of Erasmus MC research projects
Research project


Status: Ongoing project

In this study, the prophylactic effect of scopolamine butyl is investigated on death rattle in a double blind placebo-controlled randomized study

What we do

About our project

Death rattle is defined as ‘noisy breathing caused by the presence of mucus in the upper respiratory tract’. This phenomenon is a common symptom in the last days of life, where 12–92% of patients in the dying phase have been reported to develop death rattle. Professionals assume that patients do not experience distress from death rattle because their consciousness is reduced in the dying phase.

For the relatives, the rattling noise is unpleasant and disturbing, and they may fear that their loved one is suffering and might be choking. Sixty-six percent of the relatives of patients who died in a palliative care unit indicated to experience death rattle as “very stressful” and 53% of them said that there is a great need to improve the care for and treatment of death rattle.

Anticholinergic medication is considered the standard treatment for death rattle. Anticholinergics decrease the production of mucus but do not affect existing mucus. These drugs may therefore be more effective if they are administered prophylactically, before death rattle occurs. Scopolaminebutyl is the most frequently prescribed anticholinergic drug for death rattle in the Netherlands.

We designed a randomized controlled trial (RCT) to answer our research question: is scopolaminebutyl, when given prophylactically, effective in preventing death rattle.A questionnaire will be sent to relatives three months after the patient has died to gain insight in how they experienced participation of their beloved one in research.

Funds & Grants

This project is supported by ZonMw.


Collaborations within Erasmus MC

  • Department of Public Health, research group: medical decisions in end-of-life care.

Collaborations outside of Erasmus MC


Scopolaminebutyl given prophylactically for death rattle: study protocol of a randomized double-blind placebo-controlled trial in a frail patient population (the SILENCE study) Harriëtte J. van Esch, Lia van Zuylen, Esther Oomen-de Hoop, Agnes van der Heide, Carin C. D. van der Rijt. (2018) BMC Palliat Care. 2018; 17: 105.

Our team

  • Carin van der Rijt
  • Lia van Zuylen
  • Agnes van der Heiden
  • Jet van Esch