Evaluating few-shot prompting for spectrogram-based lung sound classification using a multimodal language model

Traditional deep learning models for lung sound analysis require large, labeled datasets, whereas multimodal large language models (LLMs) may offer a flexible, prompt-based alternative. This study aimed to evaluate the utility of a general-purpose multimodal LLM, GPT-4o, for lung sound classification from mel-spectrograms and assess whether a few-shot prompt approach improves performance over zero-shot prompting. Using the ICBHI 2017 Respiratory Sound Database, 6898 annotated respiratory cycles were converted into mel-spectrograms. GPT-4o was prompted to classify each spectrogram using both zero-shot and few-shot strategies. Model outputs were evaluated against ground truth labels using performance metrics including accuracy, precision, recall, and F1-score. Few-shot prompting improved overall accuracy (0.363 vs. 0.320) and yielded modest gains in precision (0.316 vs. 0.283), recall (0.300 vs. 0.287), and F1-score (0.308 vs. 0.285) across labels. McNemar's test indicated a statistically significant difference in performance between prompting strategies (p < 0.001). Model repeatability analysis demonstrated high agreement (κ = 0.76-0.88; agreement: 89-96%), indicating excellent consistency. GPT-4o demonstrated limited but statistically significant performance gains using few-shot prompting for lung sound classification. While current performance remains insufficient for clinical deployment, this prompt-based approach provides a baseline for spectrogram-based multimodal tasks and a foundation for future exploration of prompt-based multimodal inference.