June 13, 2001 -- Many kids have asthma, but few are getting the treatment they need to control it, recent studies show. Parents have questions about the medications -- their safety and long-term effects. And some research about pets in the home has been conflicting. Also, do emotions and stress play a role in childhood asthma? What should parents do?

To find answers, WebMD interviewed some of the country's asthma experts:

Do steroid allergy medications stunt growth?

"That is the number one concern I hear from parents of patients I see," says Steven R. Boas, MD, medical director of the pulmonary function and exercise labs at Children's Memorial Hospital and assistant professor at Northwestern University Medical School, both in Chicago.

Recent studies "have almost put that issue to rest," Boas tells WebMD. Several studies published last year looking at long-term growth showed that kids taking regular inhaled steroid medications will achieve their adult height, that there is no long-term impact on growth. "So that's no longer a valid issue," he says.

"Some might even argue that not giving medication would impact long-term growth -- that it would impact the child's overall health," he says. "Chronic asthma is associated with poorer growth."

Isn't the goal to get kids off steroid medications at some point?

No, says Boas. In fact, studies are showing that even those with mild asthma suffer damaging changes in lung tissues and cells (called airway remodeling). The changes seem to lead to persistent, harder-to-control asthma, he tells WebMD. Regular use of asthma medication has been shown to reverse those changes, he says.

"We can't just be giving a child medication depending on how he feels today," Boas tells WebMD. "If a child has persistent asthma, we need to be giving him steroid medications on a daily basis."

When treating a child for allergies, the first goal is to get symptoms under control, says Boas. "Then we should establish the minimum amount of medication necessary to keep symptoms under control."

For most people, medication can be significantly reduced. "But it does not mean they come off medication entirely," he says. "With what we know about airway remodeling, I would be more hesitant to take someone off medicine completely. My goal is to minimize what they need, but make sure we're not cheating them or compromising lung function."

What about pets? Do they make allergies and asthma worse? Or do they help prevent allergies later on?

"If children already have asthma -- absolutely, pets should be removed from the home," says David Rosenstreich, MD, director of allergy and immunology at Albert Einstein School of Medicine in New York.

"Removing allergens is the single most effective treatment method -- and focus on keeping the bedroom as allergen-free as possible," Rosenstreich tells WebMD. "I personally don't think it's a good idea to have allergenic substances -- mainly cats -- in the home of children who have the potential to develop asthma."

Should pets be allowed to live in a child's home during the first few years -- if the child is at high risk for allergies? While some studies have shown that early exposure may reduce incidence of asthma, it's really not clear if that's true, he says.

It's called the "hygiene hypothesis" -- that our western culture is too clean and that by introducing allergens early in life, allergies can be prevented.

That theory just has not yet been proven, says Rosenstreich. "In my personal opinion, it's a risky thing to do until we really know what's going on."

How can you best rid your home of allergens?

"Forty percent of doctor-diagnosed asthma can be traced to allergen exposures in the home," says Bruce Lanphear, MD, MPH, associate professor of pediatrics at Children's Hospital Medical Center of Cincinnati.

Giving away the family pet is one solution, since cat and dog dander is a significant allergen for many kids. Barring that, it can be difficult to remove all the allergens in your home -- cat and dog dander, dust mites, cockroaches. But it is possible to make reductions, Lanphear tells WebMD.

Some suggestions:

• HEPA air filters may provide some benefit in getting allergens out of the air. If filters are used continuously, they will reduce airborne cat dander. At least one study shows that children with pet dander allergies will do better with air cleaners in their bedrooms.

• Carpets in poor condition act as reservoirs for indoor allergens, especially pets and dust mites. They should be replaced or removed entirely and wood or other hard-surface flooring installed.

• Pest management can help with cockroach control.

• Regular vacuuming (using vacuums with HEPA filters) or steam cleaning upholstered furniture and carpets helps control dust mites.

• Keep box springs, mattresses, and pillows enclosed in zippered allergen-proof casings, which can be purchased at any linen store.

• Use dehumidifiers and air conditioners to get rid of airborne allergens and the humidity that fosters them.

• Wash sheets and pillowcases in hot water to kill dust mites.

• Close vents or put vent filter paper over them to cut down on fur blowing through the house (assuming Puffy the cat has been allowed back in the house).

Asthma does seem to get worse during stressful times. What should parents do?

Stress and depression can clearly lead to asthma attacks, says Bruce D. Miller, MD, professor of psychiatry and pediatrics at SUNY in Buffalo. His studies of children watching the Steven Spielberg movie ET showed dramatic heart fluctuations in those who had asthma. In a child with asthma, he says, an emotional reaction signals the nervous system to begin reacting in a way that can lead to an asthma attack.

Parents should make sure their asthmatic children are managing the emotional challenges of their lives. "Be sensitive to where your children are at emotionally; help them manage stresses," Miller tells WebMD.

If asthmatic kids are having difficulties in handling emotions and daily stresses, "take them to a counselor or other mental health professional familiar with this link between emotional factors and somatic illness," says Miller. Treating emotional triggers or the depression that some children experience can greatly improve a child's health, he says.