The product comes with an instructional manual, details of which are posted at www.exubera.com in a PDF file with 44 pages of large type, photos and questions and answers. Although an early prototype looks like it might have been a prop in a Cheech & Chong movie, the current device is much smaller. Still, patients may need to buy a carrying case because the device "is not pocket friendly," said one sales representative at the ADA meeting. The inhaler is a canister with a triggering mechanism. To engage the device, patients pull a small handle on the bottom, allowing a plastic cone to slide on top of the triggering device. Then, they insert a blister pack containing the dry-powder insulin into the triggering device. Next, they pull back on the trigger mechanism to gently pump-prime the device. Then, they press a button that releases the insulin into the plastic cone. On top of the plastic cone is a small mouthpiece, which patients use to take a slow, deep breath for five seconds. Because people require different amounts of insulin, this process may need to be repeated more than once each time diabetics take their insulin. Pfizer recommends that patients clean the plastic cone and the base once a week. The unit that releases the drug should be replaced every two weeks, and the whole device should be replaced once a year.