An aerosol delivery system, comprising: an aerosol generator that aerosolizes a fluid for delivery to a patient as a patient inhales, wherein the aerosol generator comprises a piezoelectric actuator and a vibratable member, wherein the piezoelectric actuator expands and contracts to actuate the vibratable member which aerosolizes the fluid, wherein the vibratable member is a photo-defined vibratable member capable of producing a fine particle fraction greater than 80% with particles having a diameter less than or equal to 4 microns; a pump coupled to the aerosol generator that pumps the fluid to the aerosol generator; a breath sensor that emits a signal as the patient breathes; and a controller coupled to the aerosol generator, the pump, and the breath sensor, wherein the controller receives the signal from the breath sensor, controls a flow of fluid to the aerosol generator in response to the signal, and controls the aerosol generator to start aerosolizing the fluid before or during the inhalation cycle, wherein the pump couples to the aerosol generator with a fluid delivery conduit that is primed with the fluid, a fluid source fluidly coupled to the aerosol generator with the fluid delivery conduit, and the controller is configured to cause fluid in the fluid source to be pumped by the pump through the fluid delivery conduit to the aerosol generator where the fluid is aerosolized before and/or while the patient inhales, in which the controller is configured to time delivery and the amount of fluid received by the aerosol generator and to coordinate fluid delivery and then aerosolization of the fluid by communicating with the breath sensor, wherein the aerosol generator includes a housing for the aerosol generator and the controller is configured to drive the pump to force fluid through the fluid delivery conduit and into the housing, and the aerosol delivery system further comprises a tube adapter, wherein the housing extends through an aperture in the tube adapter so that aerosolized fluid exits a housing outlet closer to a central axis of the tube adapter, to enable a carrier fluid stream passing through the tube adapter to capture more of aerosol for delivery to the patient. an aerosol generator that aerosolizes a fluid for delivery to a patient as a patient inhales, wherein the aerosol generator comprises a piezoelectric actuator and a vibratable member, wherein the piezoelectric actuator expands and contracts to actuate the vibratable member which aerosolizes the fluid, wherein the vibratable member is a photo-defined vibratable member capable of producing a fine particle fraction greater than 80% with particles having a diameter less than or equal to 4 microns; a pump coupled to the aerosol generator that pumps the fluid to the aerosol generator; a breath sensor that emits a signal as the patient breathes; and a controller coupled to the aerosol generator, the pump, and the breath sensor, wherein the controller receives the signal from the breath sensor, controls a flow of fluid to the aerosol generator in response to the signal, and controls the aerosol generator to start aerosolizing the fluid before or during the inhalation cycle, wherein the pump couples to the aerosol generator with a fluid delivery conduit that is primed with the fluid, a fluid source fluidly coupled to the aerosol generator with the fluid delivery conduit, and the controller is configured to cause fluid in the fluid source to be pumped by the pump through the fluid delivery conduit to the aerosol generator where the fluid is aerosolized before and/or while the patient inhales, in which the controller is configured to time delivery and the amount of fluid received by the aerosol generator and to coordinate fluid delivery and then aerosolization of the fluid by communicating with the breath sensor, wherein the aerosol generator includes a housing for the aerosol generator and the controller is configured to drive the pump to force fluid through the fluid delivery conduit and into the housing, and the aerosol delivery system further comprises a tube adapter, wherein the housing extends through an aperture in the tube adapter so that aerosolized fluid exits a housing outlet closer to a central axis of the tube adapter, to enable a carrier fluid stream passing through the tube adapter to capture more of aerosol for delivery to the patient.