Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest . The lungs are again hyperinflated with flattening of the diaphragms consistent with obstructive lung disease . Chronic interstitial markings bilaterally are again seen , consistent with chronic lung disease . Heart size is normal . The mediastinal and hilar contours are normal . There is no focal consolidation , pleural effusion or pneumothorax .
    OUTPUT:
    
Unchanged emphysema and coarse interstitial markings . No acute cardiopulmonary process . No change since ___ .