Purpose of review: Noisy respiratory secretions at the end of life are common and sometimes very distressing for those caring for the dying person. Understanding of the pathophysiology is limited but is probably more complex than current opinion would suggest. As a result, the management of this problem is poor.
Recent findings: This study considers current definitions and proposes a three-step mechanism to account for the phenomena. The current evidence to describe contributing causes and management is discussed, and a research agenda is proposed.
Summary: A more sophisticated approach when assessing and managing respiratory secretions is necessary, including methods to adopt preemptive strategies. Research that explores the benefit of compassionate education and communication with people close to the dying person must be explored.