There are two kinds of quantum fluctuations relevant to cosmology that we focus on in this article: those that form the seeds for structure formation in the early universe and those giving rise to Boltzmann brains in the late universe. First, structure formation requires slight inhomogeneities in the density of matter in the early universe, which then get amplified by the effect of gravity, leading to clumping of matter into stars and galaxies. According to inflation theory, quantum fluctuations form the seeds of these inhomogeneities. However, these quantum fluctuations are described by a quantum state which is homogeneous and isotropic, and this raises a problem, connected to the foundations of quantum theory, as the unitary evolution alone cannot break the symmetry of the quantum state. Second, Boltzmann brains are random agglomerates of particles that, by extreme coincidence, form functioning brains. Unlikely as these coincidences are, they seem to be predicted to occur in a quantum universe as vacuum fluctuations if the universe continues to exist for an infinite (or just very long) time, in fact to occur over and over, even forming the majority of all brains in the history of the universe. We provide a brief introduction to the Bohmian version of quantum theory and explain why in this version, Boltzmann brains, an undesirable kind of fluctuation, do not occur (or at least not often), while inhomogeneous seeds for structure formation, a desirable kind of fluctuation, do.