The early signs of chronic obstructive pulmonary emphysema may not be obvious, but as the disease progresses, signs of emphysema may appear, such as barrel-shaped chest, enlarged anterior and posterior thoracic diameters, widened rib space, reduced respiratory motion and fibrillation in both lungs, percussion of both lungs with hyperclear sounds, downward shift of the lower lung border, reduced mobility, narrowing or disappearance of the cardiac turbinate border, downward shift of the hepatic turbinate border, weakened alveolar breath sounds, prolonged expiratory phase, dry and wet rales can be heard at the base of both lungs.