This is a patient with moderate persistent asthma maintained on Singulair, inhaled steroids, and prn albuterol. He was brought to the emergency department (ED) with an upper respiratory infection (URI), cough, and wheezing that was not better after three albuterol treatments at home. On arrival, he was afebrile, respiratory rate (RR) was 24, and oxygen saturation 98% on room air. The physician note states he is in no apparent distress, speaking in full sentences, with normal respiratory effort, normal breath sounds, no respiratory distress, no wheeze, no rhonchi, and no rales. The health plan's determination is upheld. This patient with moderate persistent asthma presented with a mild pulmonary exacerbation from a URI. He was well hydrated and perfused. He did not have hypoxemia, retractions, or anything more than very mild tachypnea. There was no concern regarding his caregiver's ability to manage him at home or concern that he might tire. The hospitalization appears to have occurred to extinguish his wheezing, which did not require acute inpatient management absent other reasons, such as significant distress or hypoxemia.