Abstract: Acute respiratory distress syndrome (ARDS) is a common respiratory critical disease caused by systemic inflammatory response induced by severe infection, shock, trauma and other factors, with high morbidity and mortality. The structural and functional dysfunction of the air-blood barrier is the key mechanism in its occurrence, development and outcome, and the alveolar epithelial cells and pulmonary vascular endothelial cells play central roles in this progress. Prevention and treatment of the air-blood barrier injury has great effects on the outcome of the disease. In this article, we review the latest research on the air-blood barrier, including the changes of the air-blood barrier structure and function in ARDS and targeted therapies including traditional Chinese medicine, in order to provide more references for clinical rational diagnosis and treatment.