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<h3>Introduction</h3> Respiratory and oropharyngeal secretions present significant challenges in motor neurone disease (MND). Symptoms such as choking and impaired cough compromise quality of life, place burdens on unpaid carers, and limit the effectiveness of interventions including non-invasive ventilation. Despite their prevalence, good symptom management is rare. <h3>Aims</h3> The session Aims to: Describe the complexity of secretion management in MND. Consider the Impact of cough, choking, and secretion difficulties on patients and carers. Present emerging evidence and co-produced interventions to improve practice. <h3>Methods</h3> Speakers will present perspectives informed by clinical research and co-production with people living with MND. Topics include healthcare professional challenges, development of assessment tools, co-designed clinical management plans for choking, and approaches to sialorrhea management in complex neurological disability. A person living with MND will provide a lived experience perspective. The 45-minute session will combine structured presentations with panel discussion and case studies. <h3>Results</h3> The session will highlight the multifactorial nature of secretion management, the need for individualised approaches to cough augmentation, and the importance of equipping clinicians with confidence to respond to choking episodes. Co-production with patients and carers will underpin practical guidance and assessment tools, ensuring interventions are clinically relevant and acceptable. Lessons from specialist neurological care will broaden understanding of transferable strategies for secretion management. <h3>Conclusion</h3> Effective management of cough and secretions in MND require integrated, patient-centred solutions. Collaborative approaches between clinicians, researchers, and people living with MND will generate interventions that address unmet needs in palliative care. <h3>Impact</h3> This work will strengthen professional knowledge and confidence, support equitable palliative care for non-cancer conditions, and demonstrate the value of co-production. It will provide a model for improving symptom management and quality of life in MND and related neurodegenerative diseases.