Objective To investigate the clinical efficiency and value of adjuvant therapy with glucocorticoid in the treatment of the elderly patients with caseous pneumonia. Methods A total of92 old patients with caseous pneumonia admitted in our department from January 2015 to August 2016 were enrolled in this study. According to their treatment regimens, they were divided into the observation and control groups. The control group was only treated with conventional anti-tuberculosis therapy, while the observation group was given adjuvant therapy with glucocorticoid. The clinical conditions, such as symptoms, lesions absorption, sputum negative conversion and so on, were compared between the 2 groups at 4,6, 8 weeks after the treatment. SPSS 22.0 software was used to perform the statistical awalysis. The data were compared with t test or Chi-square test. Results Compared with the control group, the main symptoms were more significantly alleviated in observation group in 4,6 and 8 weeks after treatment (60.9% vs 28.3%, 73.9% vs 47.8%, 91.3% vs 71.7%; P<0.05). The observation group had better total absorption of pulmonary lesions than the control group (52.2% vs 28.3%, 76.1% vs 45.7%, 95.7% vs 73.9%; P<0.05), but no difference was seen in the sputum negative conversion rates between the 2 groups (34.2% vs 40.5%, 60.5% vs 52.4%, 71.1% vs 73.8%; P>0.05). Conclusion Short term application of glucocorticoid is safe for the elderly patients with caseous pneumonia. It is also beneficial to the absorption of inflammation in the lungs and to the reliefs of tuberculosis symptoms.