Abstract
Respiratory diseases pose a significant global health burden, with challenges in early and accurate diagnosis due to overlapping clinical symptoms, which often leads to misdiagnosis or delayed treatment. To address this issue, we developed LungDiag, an artificial intelligence (AI)-based diagnostic system that utilizes natural language processing (NLP) to extract key clinical features from electronic health records (EHRs) for the accurate classification of respiratory diseases. This study employed a large cohort of 31,267 EHRs from multiple centers for model training and internal testing. Additionally, prospective real-world validation was conducted using 1142 EHRs from three external centers. LungDiag demonstrated superior diagnostic performance, achieving an F1 score of 0.711 for top 1 diagnosis and 0.927 for top 3 diagnoses. In real-world testing, LungDiag outperformed both human experts and ChatGPT 4.0, achieving an F1 score of 0.651 for top 1 diagnosis. The study emphasizes the potential of LungDiag as an effective tool to support physicians in diagnosing respiratory diseases more accurately and efficiently. Despite the promising results, further large-scale multicenter validation with larger sample sizes is still needed to confirm its clinical utility and generalizability.