Leukotriene modifiers include LTRAs and leukotriene inhibitors, which both act as anti-inflammatory medications. LTRAs block leukotriene receptors, whereas leukotriene inhibitors block the production of 5-lipoxygenase. The two LTRAs licensed in the United States are montelukast (Singulair) and zafirlukast (Accolate). LTRAs may be used as monotherapy for mild persistent asthma, but are considered second-line agents based on the EPR-3 10 and GINA guidelines. 30 For mild to moderate asthma, the risk of exacerbation is approximately 50% less in patients prescribed an inhaled corticosteroid compared with those prescribed an LTRA. 15 A 2014 Cochrane review found an LABA plus inhaled corticosteroid to be modestly superior to an LTRA plus inhaled corticosteroid in adults with inadequately controlled asthma. 26 LTRAs are best used to improve pulmonary function in patients with aspirin-sensitive asthma 31 and to decrease symptoms in exercise-induced bronchospasm. 32 , 33 They should also be considered in patients with mild persistent asthma who prefer not to use inhaled corticosteroids. Although LTRAs generally have few adverse effects, physicians should be aware of rare case reports of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome), psychiatric symptoms, hypertriglyceridemia, angioedema, urticaria, and glomerulonephritis. 34
In Northern Iran , Mâst Chekide is a variety of kefir yogurt with a distinct sour taste. It is usually mixed with a pesto-like water and fresh herb purée called delal . Yogurt is a side dish to all Iranian meals . The most popular appetizers are spinach or eggplant borani , Mâst-o-Khiâr with cucumber, spring onions and herbs, and Mâst-Musir with wild shallots . In the summertime, yogurt and ice cubes are mixed together with cucumbers, raisins , salt, pepper and onions and topped with some croutons made of Persian traditional bread and served as a cold soup. Ashe-Mâst is a warm yogurt soup with fresh herbs, spinach and lentils. Even the leftover water extracted when straining yogurt is cooked to make a sour cream sauce called kashk , which is usually used as a topping on soups and stews.