# Empowering Multimodal Respiratory Sound Classification with Counterfactual Adversarial Debiasing for Out-of-Distribution Robustness

arXiv: https://arxiv.org/abs/2510.22263 · HTML: https://mlsanity.com/paper/2510.22263/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 25 Oct 2025.

## Built on by (most cited first, 4 of 4)

- [Mitigating Stethoscope-Induced Shortcuts in Respiratory Sound Classification under Federated Domain Generalization with Causality-Inspired Interventions](https://mlsanity.com/paper/2605.29862/) (2026)
- [Meta-Ensemble Learning with Diverse Data Splits for Improved Respiratory Sound Classification](https://mlsanity.com/paper/2604.24096/) (2026)
- [Quality Adaptive Angular Margin Learning for Respiratory Sound Classification](https://mlsanity.com/paper/2606.11915/) (2026)
- [Lung-SRAD: Spectral-Aware Regularized Audio DASS with Dual-Axis Patch-Mix Contrastive Learning for Respiratory Sound Classification](https://mlsanity.com/paper/2606.11922/) (2026)

## Abstract (arXiv)

Multimodal respiratory sound classification offers promise for early pulmonary disease detection by integrating bioacoustic signals with patient metadata. Nevertheless, current approaches remain vulnerable to spurious correlations from attributes such as age, sex, or acquisition device, which hinder their generalization, especially under distribution shifts across clinical sites. To this end, we propose a counterfactual adversarial debiasing framework. First, we employ a causal graph-based counterfactual debiasing methodology to suppress non-causal dependencies from patient metadata. Second, we introduce adversarial debiasing to learn metadata-insensitive representations and reduce metadata-specific biases. Third, we design counterfactual metadata augmentation to mitigate spurious correlations further and strengthen metadata-invariant representations. By doing so, our method consistently outperforms strong baselines in evaluations under both in-distribution and distribution shifts. Code is available at https://github.com/RSC-Toolkit/BTS-CARD.