Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs again are severely hyperinflated , consistent with emphysema . The changes are more pronounced at the apices . The lungs are clear of any focal airspace consolidations , pleural effusions , or pneumothoraces . The cardiomediastinal silhouette is stable .
    OUTPUT:
    
COPD without superimposed pneumonia .