Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: PA and lateral views of the chest provided . Left chest wall pacer device is seen with leads extending to the region of the right atrium and right ventricle unchanged . Midline sternotomy wires , mediastinal clips and a prosthetic cardiac valve again noted . The lungs are hyperinflated , lucent and clear . No large effusion or pneumothorax is seen . The cardiomediastinal silhouette is normal . Bony structures appear intact . No free air is seen below the right hemidiaphragm .
    OUTPUT:
    
COPD without acute findings .