In the present issue of the European Respiratory Journal, Berger et al. [1] report the lack of efficacy of inhaled budesonide for the prevention of acute mountain sickness (AMS). This small well-designed study was undertaken to verify or refute the provocative finding of robust protection with budesonide against AMS reported by Chinese colleagues in 2014 [2] and 2015 [3]. In the presently reported study, 50 healthy volunteers were randomly assigned to inhale twice daily budesonide 200 µg, budesonide 800 µg or a placebo 1 day prior and during climbing in less than 48 h to an altitude of 4559 m. Such a rapid active ascent is known to be associated with a more than 50% incidence of AMS symptomatology [4]. Accordingly, AMS indeed occurred in 53% of the subjects in the placebo group, and in 56% and 76% of the subjects assigned to the 200 µg and 800 µg budesonide groups, respectively. Between group differences were not significant. Clearly, inhaled budesonide did not prevent acute mountain sickness.