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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.

The review is devoted to safety issues of herbal medicinal products. Apart from the most known adverse effects such as allergic reactions and irritation ofmucous membranes, use of a number of herbal medicines results in hormonal disturbances, organotoxic reactions and CNS disturbances. The problem of intoxication is pressing in case of uncontrolled administration of herbal remedies, which is often accompanied by a carefree attitude towards them as natural and thus safe agents. This assurance is developed in the result of non-ethical advertising of dietary supplements in mass media. Finally, an important factor of safe therapy is comprehensive accounting of potential herb-herb and herb-drug interactions. The purpose of the article is to attract attention to a weighted attitude towards phytotherapy concerning its safety both in administration of traditional herbal medicinal products by doctors and during self-treatment bypatients.