Purpose <p>Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that limits airflow, and its effective management often depends on the precise timing of bronchodilator delivery. Current manual administration methods of aerosols using bronchodilators frequently lead to poor clinical outcomes, reduced therapeutic efficacy, and increased burden on healthcare providers due to the challenge of actuation-inhalation coordination in usage. This study presents the development of an automated metered dosage inhaler (MDI) delivery system incorporating breath detection to improve actuation-inhalation coordination during bronchodilator therapy in ventilated patients.</p> Methods <p>Following system requirements, an automated MDI delivery system was designed and integrated with a breath detection mechanism to detect inhalation phases and actuate the MDI in synchronisation with patient breaths. Bench testing using a breathing stimulator assessed timing accuracy and aerosol release dynamics under simulated ventilatory conditions.</p> Results <p>Validation experiments consistently show the system’s ability to achieve actuation within the optimal time window of 0–0.2&#xa0;s post-inhalation onset. This significantly improves upon the variability of manual methods in bronchodilator therapy. The performance tests confirm the device’s accuracy in detecting inhalation, synchronising actuation, and maintaining dosage consistency, further showcasing its potential to improve clinical outcomes and patient comfort in intensive care units.</p> Conclusion <p>The system achieved consistent actuation-inhalation synchronization with reduced variability, though limitations remain in size and durability. The findings improve the understanding of actuation-inhalation coordination and offer a promising solution to the challenges of bronchodilator delivery in mechanically ventilated COPD patients.</p>