An aerosol delivery system (e.g., MDI or nebulizer for delivering aerosolized medication to a patient) includes a temperature sensor in an aerosol output pathway of the system. A controller determines that an aerosol generator of the system has released aerosol when the sensor senses a predetermined temperature change in the pathway. The temperature sensor may also comprise a thermal flow sensor that includes a heater and upstream and downstream temperature sensors. The controller compares the upstream and downstream temperatures to determine the presence, direction, and/or magnitude of fluid flow in the pathway. The controller may use the aerosol detection and/or flow detection to monitor compliance with desired use of the system and/or provide real-time instructions to a user for proper use of the system. The controller may record the aerosolization and flow data for later analysis.