Treating dyspnea in patients with idiopathic pulmonary fibrosis is a challenge. The foreign experience of using low doses of opioids to relieve dyspnea in patients with progressing diseases is controversial among Russian specialists. The presented clinical case is an 83-year-old patient with idiopathic pulmonary fibrosis in the terminal stage and refractory dyspnea, progressive respiratory failure of II - III degrees, and concomitant exertional angina II FC and organic anxiety disorder. The patient was offered low-dose morphine injections (2 mg 5 times a day subcutaneously) to relieve the shortness of breath. The patient, who had not previously received opioids, and his relatives gave prior consent to the use of morphine. Within a week from the moment of hospitalization, the general and psycho-emotional state of the patient improved, dyspnea decreased, and night sleep was partially normalized. However, а week later, being in a severe but relatively stable condition, the patient died from a massive nosebleed. Shown, that the traditional approach to reducing dyspnea and the associated agitation in patients with interstitial lung disease is the use of corticosteroids and psychotropic therapeutics in increasing doses. The use of low doses of opioids to relieve dyspnea in patients with non-cancer disease meets many organizational, medical, and psychological barriers. At the same time, this therapy is recognized as successful and safe in the foreign palliative practice. Overcoming the existing barriers based on the evidence from clinical trials, as well as the domestic and foreign clinical practice of the safe use of low doses of opioids would expand the arsenal of effective treatments for refractory dyspnea.

Objective. The study objective is to assess the efficacy of preventive care for thromboembolic complications after endoprosthetics of large joints depending on patients’ compliance.Methods: Prospective clinical examination of 686 patients aged 50–70 years, who underwent the endoprosthetics of knee and hip joints. Preventive care for thrombosis and embolism was performed according to three regimens: 1) monotherapy with parenteral low molecular weight heparins, 2) therapy with low molecular weight heparins converted to indirect anticoagulants, 3) administration of oral anticoagulants.Results: 376 patients (54.8%) fully complied with the medical recommendations. The rest 310 patients (45.2%), non-compliant patients, ignored medical prescriptions: refusal to take anticoagulants, spontaneous replacement of anticoagulants with antiplatelet agents, not taking medications as prescribed. Among compliant patients, deep vein thrombosis of lower extremities was registered in 9 cases (2.4%); among non-compliant patients, it was registered in 13 cases (4.2%).Conclusions: Deep vein thrombosis of lower extremities was registered significantly more often in non-compliant patients. To increase the efficacy of the prevention care for thromboembolic complications after endoprosthetics of large joints, more attention should be paid to explanatory work, explaining to patients the nature and negative consequences of compliance violations.