Despite the presence of a number of anecdotal reports in the mountaineering literature, mucociliary dysfunction at high altitude has received little scientific attention. However, the dry, cold, thin air at high altitude has the potential to undermine normal mucociliary function. This seems increasingly likely in mountaineers who also experience dehydration, nasal obstruction, and extremes of aerobic respiration when climbing in such environments. These factors may result in a number of clinical conditions that range from sore throats and coughs commonly seen at altitude to rarer cases of bronchiolar collapse and lung atelectasis. The purpose of this review is to discuss the etiology of mucociliary dysfunction at altitude and outline a number of potential solutions to the problems this phenomenon presents.