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Letter
Propantheline for excess respiratory tract secretions in motor neuron disease
  1. Sarah Marshall and
  2. Mark Banting
  1. Palliative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Mark Banting, Palliative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; mark.banting{at}uhs.nhs.uk

https://doi.org/10.1136/spcare-2022-004109

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    Motor neuron disease (MND) is a progressive and debilitating condition with symptom control complexity. One of the symptoms that causes a large burden to patients is that of excessive secretions (sialorrhoea). The evidence base for treatment options is small or non-existent.

    We wish to present a case in which we used parenteral feeding tube (radiologically inserted gastrostomy, RIG) administered propantheline to control a patient’s sialorrhoea.

    Our patient was a 54-year-old female who had end-stage MND of bulbar onset. She was bedbound and due to fatigue, she was no longer able to use her eye gaze device so her only way of communicating was through eye movements. She was admitted from home to the acute hospital with increased shortness of breath and increased secretions. Her anti-secretory medication on admission was amitriptyline 10 mg two times per day, via her RIG.

    She was treated with intravenous antibiotics, which improved her breathlessness. However, the secretions remained copious, which necessitated multiple daily interventions from the ward physiotherapists using her cough assist to help her clear them.

    In between infections, she consistently had excessive respiratory tract secretions which troubled her. The secretions were watery and …

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    Footnotes

    • Contributors This work is a joint piece of work by MB and SM who have been involved in all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.