Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperinflated with severe emphysematous changes again noted . The cardiac , mediastinal and hilar contours are unchanged , with a small hiatal hernia again noted . There is no pulmonary vascular congestion . Increased interstitial markings in the lung bases appear slightly increased compared to the prior chest radiograph , particularly in the right lung base , with associated bronchiectasis and bronchial wall thickening compatible with an airways inflammatory or infectious process . No pneumothorax or pleural effusion is demonstrated . No acute osseous abnormalities are identified .
    OUTPUT:
    
Increased interstitial opacities in the lung bases , more so on the right , with associated bronchiectasis and bronchial wall thickening . Findings are concerning for acute on chronic bronchial inflammation and / or infection including ___ or aspiration .