Resp-Agent: An Agent-Based System for Multimodal Respiratory Sound Generation and Disease Diagnosis

Abstract

Deep learning-based respiratory auscultation is currently hindered by two fundamental challenges: (i) inherent information loss, as converting signals into spectrograms discards transient acoustic events and clinical context; (ii) limited data availability, exacerbated by severe class imbalance. To bridge these gaps, we present Resp-Agent, an autonomous multimodal system orchestrated by a novel Active Adversarial Curriculum Agent (Thinker-A$^2$CA). Unlike static pipelines, Thinker-A$^2$CA serves as a central controller that actively identifies diagnostic weaknesses and schedules targeted synthesis in a closed loop. To address the representation gap, we introduce a Modality-Weaving Diagnoser that weaves EHR data with audio tokens via Strategic Global Attention and sparse audio anchors, capturing both long-range clinical context and millisecond-level transients. To address the data gap, we design a Flow Matching Generator that adapts a text-only Large Language Model (LLM) via modality injection, decoupling pathological content from acoustic style to synthesize hard-to-diagnose samples. As a foundation for these efforts, we introduce Resp-229k, a benchmark corpus of 229k recordings paired with LLM-distilled clinical narratives. Extensive experiments demonstrate that Resp-Agent consistently outperforms prior approaches across diverse evaluation settings, improving diagnostic robustness under data scarcity and long-tailed class imbalance. Our code and data are available at https://github.com/zpforlove/Resp-Agent.