A retrospective analysis was performed to study the occurrence and treatment of death rattle (DR) in 107 consecutive dying patients on the palliative care unit of the University Hospital Leuven. The incidence of DR (23%) is lower than reported in literature, possibly due to low hydration. We found 2 types of rattle: "Real DR" responds generally very well to anticholinergic therapy, and is probably caused by non-expectorated secretions. "Pseudo DR" is poorly responsive to therapy and is probably caused by bronchial secretions due to pulmonary pathology, such as infection, tumor, fluid retention, or aspiration. Rattle disappeared in >90% for the patients with real DR. Real DR is a strong predictor for death, and 76% (19/25) died within 48h after onset. Administration of subcutaneous hyoscine hydrobromide, as a bolus or continuous infusion, is effective therapy for real DR and is comfortable for the patient and caregivers.