Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperexpanded similar to the prior study with emphysematous changes . Heart size is normal . The mediastinal and hilar contours are normal . There is no pleural effusion or pneumothorax . There is anterior fusion of several upper thoracic levels .
    OUTPUT:
    
COPD without evidence of acute abnormality .