Early X-rays of chronic obstructive pulmonary disease (COPD) may show no abnormal changes, and in the middle and late stages, there may be emphysema manifestations, non-specific changes such as thickening of the lung texture, as well as the manifestation of complications. In the early stage of chronic obstructive pulmonary disease, structural changes in the lungs are not obvious, so there may be no abnormal changes on chest radiographs. In the middle and late stages of COPD, there are nonspecific changes such as thickening and disorganization of the lung texture and hardening and thickening of the bronchial walls. Emphysematous lesions may result in more specific changes such as widening of the intercostal spaces, a low and flat diaphragm, cardiac compression with a drop-shaped heart, and increased translucency in both lungs. Complications include pneumonia, spontaneous pneumothorax, etc. The former manifests as patchy, cloudy shadows in the lungs, while the latter manifests as no lung texture outside the pneumothorax line and compressed lung tissue inside the pneumothorax line. X-ray chest radiographs do not have high diagnostic specificity for chronic obstructive pulmonary disease, and can be used to differentiate from other lung diseases, generally still need pulmonary function tests to confirm the diagnosis of chronic obstructive pulmonary disease. It is recommended that patients with suspected chronic obstructive pulmonary disease should seek prompt medical attention and follow the doctor’s instructions for examination and treatment.