Abstract A sensitive and highly selective liquid chromatography tandem mass spectrometric (LC/MS/MS) method was developed and validated for the determination of ciclesonide (CIC) and its active metabolite, desisobutyryl-ciclesonide (des-CIC), in human plasma. Plasma samples were extracted using methyl tert-butyl ether with mifepristone as an internal standard (IS). Separation was carried out on a C 18 column using a mixture of 0.1% formic acid solution and methanol as the mobile phase with linear gradient elution. The detection was operated with positive atmospheric pressure chemical ionization (APCI) by selective multiple reaction monitoring (SRM). The chief benefit of the present method was the high sensitivity, with the lower limit of quantification (LLOQ) as low as 10 pg/mL and the linearity ranging from 10 to 10,000 pg/mL for both CIC and des-CIC. The method was fully validated and successfully applied to determine CIC and des-CIC simultaneously in human plasma and proved to be suitable for phase I clinical pharmacokinetic study of inhaled ciclesonide in healthy Chinese volunteers.