Introduction: The evaluation of new treatment strategies in dying patients is ethically complex. The Liverpool Care Pathway for the Dying Patient (LCP) can be a useful tool to contribute to the evidence base for the care of the dying. Glycopyrronium is used for the treatment of respiratory tract secretions (RTS) in the dying patient, but the evidence base for this is limited. This study compares the effectiveness of glycopyrronium versus hyoscine hydrobromide in the management of RTS in dying patients.
Methods and Results: In a 30-bedded palliative care unit glycopyrronium was introduced as the drug of choice for RTS in dying patients in August 2002. RTS are treated according to an agreed standard protocol. Patients on an LCP have RTS, agitation and pain recorded every four hours as present or absent. Over a prospective ten-month period there were 77 patients who died with RTS and were treated with glycopyrronium for more than four hours before death. 36 of these patients were matched for age (within seven years), diagnosis and gender with 36 patients from a cohort of 59 patients who had died with RTS at the unit in 1999 and had been treated with hyoscine hydrobromide. Overall 100% of patients responded to glycopyrronium compared to 78% to hyoscine hydrobromide. Some patients had a transient response. At death 72% in the glycopyrronium group and 58% in the hyoscine group had RTS controlled. However overall there was no statistically significant difference in response rate between the two groups.
Conclusion: The LCP is an effective and ethically acceptable tool in the evaluation of new treatment strategies in dying patients.