Objective　To observe the effect of glucocorticoid inhalation on the clinical symptoms and pulmonary fibrosis index in ARDS patients. Methods　Fifty-three ARDS patients admitted to ICU of Songjiang District Center Hospital of Shanghai from Dec. 2011 to Jun. 2013 were randomly divided into two groups. Group A (n=29) received conventional therapy, and group B (n=24) was given glucocorticoid inhalation treatment (budesonide, 2 mg, 1/12 h, for 12 days) on the basis of the conventional therapy. The oxygenation index, time of extubation, changes in pulmonary fibrosis index, including collagen Ⅰ(Co Ⅰ), Ⅲ procollagen peptide (PⅢP) and transforming growth factor (TGF-β1) were compared between the two groups, and the incidence of common adverse reactions were analyzed. Results　The oxygenation index of patients in group B was significantly improved on the 15th day compared with group A (P<0.05). There was a significant difference in the level of Co I, PⅢP and TGF-β1 between two groups as measured with enzyme-linked immunosorbent assay (P<0.05). The hormone therapy did not increase adverse effects (P>0.05). Conclusion　A small dose of glucocorticoids introduced by inhalation can improve the oxygenation index and pulmonary fibrosis level without increasing common adverse reactions, suggesting that the inhalation of corticosteroid may be a clinically safe and effective way in patients with ARDS. DOI: 10.11855/j.issn.0577-7402.2014.09.13