Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs remain significantly hyperinflated in keeping with known COPD . Bilateral lower lobe opacity is have not substantially changed . Bilateral lower reticular opacities in the lower lobes also suggests bronchiectasis . No pulmonary edema , no pleural effusions or pneumothorax . Cardiac silhouette is not enlarged .
    OUTPUT:
    
No substantial change , severe hyperinflation and bilateral lower lobe peribronchial opacities .