Introduction: The acute respiratory distress syndrome (ARDS) is a common and catastrophic condition, with a high mortality rate and economic burden on society. Despite 50 years of study, there is no specific pharmacological therapy for ARDS.

Areas covered: This review outlines the definitions, epidemiology, risk factors and pathophysiology of ARDS. The priority of developing a clinically-relevant model for ARDS to test pre-clinical candidates is discussed, together with the limitations of current models. The scientific rationale of emerging therapeutic candidates is outlined in the setting of the biological mechanisms implicated in the complex pathogenesis of ARDS. Emerging therapies, currently in clinical trials, are discussed, including the pre-clinical basis for their use and the expected timeline to trial completion.

Expert opinion: We highlight the necessity of improving pre-clinical models of ARDS and the design of clinical trials for the development of novel pharmacological therapies. We reflect on the most promising emerging strategies and their potential role in ARDS management.