BCoughBench: Benchmarking Respiratory Acoustic Foundation Models Under Body-Coupled Wearable Sensor Conditions

Respiratory acoustic foundation models (FMs) excel at cough classification, yet their ability to predict continuous health quantities from cough audio remains largely unexplored, despite the clinical value of passive age, BMI, and disease probability estimation in settings where physical measurements are unavailable. We introduce the multi-model, multi-target cough regression benchmark evaluating five FMs (OPERA-CT, OPERA-CE, OPERA-GT, HeAR, M2D+Resp) across six targets on three datasets under subject-disjoint protocols, comparing linear, MLP-small, and full MLP regression heads. MLP-small beats the mean-predictor baseline on all tasks and linear probing in 23 of 30 model x task cases, with full MLP overfitting on small clinical data but recovering on larger sets, revealing a dataset size x head-capacity trade-off. HeAR leads within-dataset age regression on Coswara (9.12 yr MAE); its CIDRZ result is excluded from headline claims owing to possible HeAR-CIDRZ pretraining overlap. OPERA-GT is favored over OPERA-CT on age in all three datasets, with the CIDRZ margin within seed variance, extending a generative-pretraining advantage from breath to cough. HeAR and M2D+Resp reach near-full performance at N = 50 samples while OPERA models require N = 400. Cross-dataset transfer is strongly asymmetric as large diverse data generalises to small clinical populations (CoughVID to CIDRZ: -0.17 yr) but not vice versa (CIDRZ to Coswara: +2.43 yr, +26.6%).

Automated cough analysis offers a path to low-cost respiratory screening, but most existing work stops at binary COVID-19 detection. A practical tool needs to tell apart several respiratory conditions from one cough recording on a consumer smartphone. We present CoughSense, a system that sorts cough recordings into five classes. These are healthy, COVID-19, asthma or respiratory condition, bronchitis, and pneumonia. We aggregated 18,301 recordings from four public datasets (Coswara, CoughVID, Virufy, and the West China Hospital Pediatric Cough Dataset) and used the OpenAI Whisper encoder as a pretrained backbone for cough disease classification. The main contribution is active-frame QKV attention pooling, which restricts attention to the first 200 of 1500 encoder tokens. This avoids the silence-dilution problem that arises because a 3-second cough fills only 150 tokens of Whisper's 30-second input window. Other training parts handle the 19 to 1 class imbalance and the four-dataset domain shift. These include WeightedRandomSampler, SpecAugment, Balanced Mixup with forced minority pairing, a supervised contrastive auxiliary loss, FiLM symptom conditioning, and gradient-reversal domain adaptation. A dual-encoder model fuses Whisper with the OPERA-CT respiratory foundation model through cross-attention. CoughSense (Whisper-tiny, 8.6M parameters) reached 82.3 percent balanced accuracy on five-fold cross-validation (macro-F1 of 0.817, AUC of 0.941). It beat an ImageNet-pretrained EfficientNet-B2 by 11.1 points and a ViT trained from scratch by 29.6 points. All five classes passed 74 percent recall and four of five passed 80 percent. The dual-encoder model reached 85.4 percent balanced accuracy. Active-frame pooling is the largest single contributor across all ablation components at 5.1 points, which should help any short-audio task using Whisper as a backbone.

Foundation models for wearable biosignals have matched or exceeded supervised specialists across a range of clinical tasks, yet all rely on modalities that require deliberate user action--wearing a device or visiting a sleep lab. We introduce BCG-FM, the first foundation model for ambient mechanical biosignals. A piezoelectric sensor embedded in the bed surface records ballistocardiography (BCG) each night without user effort; we pretrain BCG-FM with participant-level contrastive learning and using a total of 2.75 million hours of nightly recordings from 145,985 individuals, the largest raw-waveform biosignal pretraining corpus to date. Frozen BCG-FM embeddings achieve 3.26-year MAE on biological-age estimation (the lowest reported for any ambient, contactless modality) and yield clinically relevant discrimination across 15 self-reported health conditions and three independent external cohorts. Pretrained representations from only 500 labeled participants outperform a fully supervised baseline trained on 3,372, and representation quality scales log-linearly with contrastive batch size. These results establish ambient, longitudinal mechanical biosignals as a viable modality for health foundation models.