Hello, Shortness of breath can be caused by a variety of factors, and in your case, it is important to consider both the possibility of a heart-related condition and the possibility of other conditions that can affect breathing. The fact that you are on insulin does not necessarily mean that the shortness of breath is directly related to your use of insulin. Given your age, history of COPD and emphysema, and family history of congestive heart failure, it is important to consider the possibility that your shortness of breath may be related to a cardiovascular condition. A thallium stress test is a common diagnostic test used to evaluate blood flow to the heart, and can help determine if there is any blockage in the coronary arteries. In addition to heart-related conditions, other possible causes of shortness of breath include chronic obstructive pulmonary disease (COPD), asthma, lung infections, and anxiety. In the meantime, it is important to manage your blood pressure, as high blood pressure can increase the risk of heart-related conditions. It is also important to continue using your inhalers as prescribed for your COPD and emphysema. If you experience sudden, severe shortness of breath, chest pain, or other concerning symptoms, seek emergency medical attention right away. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Albana Sejdini, General & Family Physician