The insulin inhaler used to be a joking matter. Not anymore. The drugmaker is updating the labeling after reviewing clinical trial data and post-marketing reports. The actual number of cases was low - six of 4,740 Exubera patients compared with one of 4,292 patients not using the inhaler. One case was also found after Exubera became available. All of the cases, however, involved cigarette smokers, and Pfizer maintains there were too few cases to determine whether these were related to the use of the device.

The warning comes just six months after Pfizer abruptly stopped its vain efforts to make a success out of the device, which was widely derided for a cumbersome design that resembled a bong. The failure was perceived as one of the biggest pharma flops in years and the drugmaker was widely criticized for its handling of not only the marketing, but its dealing with Nektar Therapeutics, which made Exubera.

This is likely the death knell for insulin inhalers, though. Even before this latest twist, Lilly and Novo Nordisk ended their own product development plans. Nektar, which was hoping to market a newer version, has ended all negotiations with potential partners for its inhaled insulin programs, according to a statement. Only Mannkind is still working on an inhaler.