Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Hyperinflation , flattening of the diaphragms , and reticular interstitial opacities are unchanged from prior studies and consistent with chronic obstructive pulmonary disease . Ill - defined opacities at bilateral lung bases could represent infection , aspiration , or pulmonary edema in the proper clinical setting . Differentiation of these entities is difficult due to underlying extensive pulmonary parenchymal disease . Eventration of the right hemidiaphragm is unchanged . Pleural effusions are small if present at all . Cardiomediastinal silhouette and mild levoscoliosis of the thoracic spine are unchanged .
    OUTPUT:
    
1 . Opacities at bilateral lung bases may represent infection , aspiration , or pulmonary edema in the proper clinical setting . 2 . Severe underlying chronic obstructive pulmonary disease .