At first glance, I wondered why a prestigious medical journal such as Annals accepted a research article based on no more data than a questionnaire filled out by sojourners attending conferences at ski resorts [1]. The identified major symptoms of acute mountain sickness are headache, sleep disturbance, fatigue, shortness of breath, and dizziness. Couldn't these complaints be related to prolonged travel, the onset of vacation, and a bit of holiday partying?

Careful analysis of the data of Honigman and colleagues shows [1], however, that the epidemiology of the study participants' symptoms more closely follows the epidemiology of acute mountain sickness at very high altitudes. The incidence was greater in those who came from residences located at less than 3000 feet, who made no stopovers en route, who had lung disease, and who were young. Surprisingly, the correlation with alcohol use was negative.

The altitudes visited in this study were only moderate at 1920 to 3000 meters (6300 to 9700 feet), whereas acute mountain sickness has generally been thought to occur rarely at altitudes of less than 3000 meters. Much of the population of our Western Mountain states lives at elevations of 2000 to 3000 meters. The economies of Wyoming, Colorado, and New Mexico depend on the influx of tourists. The authors have convincingly presented evidence that acute mountain sickness occurs at these altitudes. The symptoms of mild acute mountain sickness are not severe enough for travelers to visit a physician in a strange environment.

Still, as hosts, we need to be more compassionate to our relatives and tourists who visit and experience these symptoms.