RAMoEA-QA: Hierarchical Specialization for Robust Respiratory Audio Question Answering

Conversational generative AI is increasingly explored in healthcare, where models must integrate heterogeneous patient signals and support diverse interaction styles while producing clinically meaningful outputs. In respiratory care, non-invasive audio recordings captured with sensing devices offer a scalable route to screening and longitudinal monitoring, but heterogeneity is particularly acute: recordings vary across devices, environments, and acquisition protocols, and queries may vary in intent, answer format, and prediction objective. Existing biomedical audio-language question answering systems for respiratory assessment are starting to emerge, but they are typically built as single-path models, processing all inputs through the same acoustic and language pathway despite variation in recording conditions and query types. They are also usually evaluated in relatively limited settings, leaving open their robustness under realistic distribution shifts, including changes in acquisition domains, modality, and clinical task. To address this gap, we introduce RAMoEA-QA, the first RA QA model designed to support input-dependent specialization across heterogeneous recordings and query types within a unified hierarchical two-stage framework. We study this design in a unified RA QA setting spanning clinical and self-recorded, multi-device acquisition settings, question formats, and both discrete and continuous targets. Across in-domain and controlled-shift evaluations, RAMoEA-QA improves over matched monolithic baselines and routing controls, reaching 0.72 in in-domain test accuracy (vs. 0.61 and 0.67 for single-path baselines) on discriminative tasks, while also achieving the best regression performance and stronger average transfer under dataset, modality, and task shifts, including gains of up to 23 percentage points in accuracy on the COPD modality-shift setting.