While the use of inhaled LABAs are still recommended in asthma guidelines for the resulting improved symptom control,  further concerns have been raised, by a large meta-analysis of the pooled results from 19 trials with 33,826 participants, that salmeterol may increase the small risks of asthma deaths, and this additional risk is not reduced with the additional use of inhaled steroids (., as with the combination product fluticasone/salmeterol ).  This seems to occur because although LABAs relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning. 
Use of QVAR with a spacer device in children less than 5 years of age is not recommended. In vitro dose characterization studies were performed with QVAR 40 mcg/actuation with the OptiChamber and AeroChamber Plus ® spacer utilizing inspiratory flows representative of children under 5 years old. These studies indicated that the amount of medication delivered through the spacing device decreased rapidly with increasing wait times of 5 to 10 seconds as shown in Table 2. If QVAR is used with a spacer device, it is important to inhale immediately.
Inhaled corticosteroids are the most effective medicine to treat persistent asthma. Inhaled corticosteroids are asthma controller medicines. Asthma symptoms happen less often when an inhaled corticosteroid is used every day. When used every day, these medicines make the breathing tubes less sensitive by blocking the inflammation that leads to asthma symptoms.
Using a controller medicine reduces the need for rescue medicines and lowers the chance of needing to go to the emergency room for an asthma attack.
Because the main problem in asthma is long-term inflammation in the lungs, corticosteroids are often used to treat asthma. Corticosteroids help to reduce and prevent the swelling and excess mucus in the airway caused by inflammation.
For most people with asthma, corticosteroids are the single most effective medicine because they break the inflammation cycle and reduce the likelihood of future asthma flare-ups.
Inhaled corticosteroids are not like anabolic steroids. Although they have a similar name, they are very different from the anabolic steroids that are abused by some athletes. Also, it is important to know that concerns about using oral corticosteroids do not apply because inhaled corticosteroids are not absorbed into the body to any large extent .
A small number of individuals experience some local side effects, such as a yeast infection (white spots) of the mouth, tongue or throat and occasional hoarseness. Side effects can be avoided by rinsing the mouth after each treatment and using a spacer with a metered dose inhaler .