Clark 2008.

Methods	Pilot phase II randomised cross‐over double‐blind controlled efficacy study
Participants	21 participants randomised; all admitted within previous 72 hours with expectation that terminal phase (last 48‐72 hours of life) would occur during that admission. 11 of the randomised participants did not receive any medication: died or secretions settled before medications administered. Of remaining 10 (5 randomised to each arm): 3 females, 7 males. Median age: 79 years (range 63‐88 years) All had advanced cancer
Interventions	Two arms: (1) Hyoscine hydrobromide 400 mcg subcutaneously, then if required, octreotide 200 mcg subcutaneously; OR (2) Octreotide 200 mcg subcutaneously, then if required, hyoscine hydrobromide 400 mcg subcutaneously. Second injection to be administered at nurse's discretion (if further intervention deemed to be required) any time after one hour following first injection.
Outcomes	Questionnaire completed by assessing nurse: intensity of noisy breathing (none, mild, moderate, severe, very severe), level of patient comfort, level of consciousness, general hydration status, state of skin at injection site, incidence of vomiting. Nurse questionnaire completed at time of each injection, and at 30 minutes, 1 hour, 4 hours and 6 hours after each injection. Median time to second injection being required: Hyoscine‐first arm: 3 hours (range 1‐8 hours) Octreotide‐first arm: 3 hours (range 1‐6 hours). After one hour: Hyoscine‐first arm: intensity of noisy breathing unchanged from baseline in 3 out of 5 people (1 out of 5 was worse) Octreotide‐first arm: intensity of noisy breathing unchanged from baseline in 4 out of 5 people
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Through hospital pharmacy's centralised service ‐ computerised sequence generation
Allocation concealment (selection bias)	Low risk	Through hospital pharmacy's centralised service ‐ blinded medication disbursement
Selective reporting (reporting bias)	Low risk	All outcomes reported
Incomplete outcome data addressed	Low risk	11 participants randomised but died or secretions settled before intervention: no possibility of measuring outcomes.
Blinding	Low risk	Through hospital pharmacy's centralised service ‐ blinded medication disbursement