Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: The lungs are hyperexpanded . There are bullous emphysematous changes in the lower lobes increased since ___ . There is no focal consolidation , pleural effusion or pneumothorax . The ascending aorta is dilated and tortuous but unchanged since ___ . The imaged upper abdomen is unremarkable .
    OUTPUT:
    
1 . Bullous emphysematous changes in the lower lobes increased since ___ . Consideration to alpha - 1 - antitrypsin deficiency should be given .