Background The body mass index (BMI), an indirect estimate of adiposity, is commonly used to assess the effect of obesity on chronic cough, albeit with conflicting findings. We investigated the impact of obesity on chronic cough in adults using the waist-to-hip circumference ratio (WHR), a more reliable measure of fat distribution.

Methods This study included adult and older subjects from the Rotterdam Study, a prospective population-based cohort. The association between general obesity (BMI ? 30 kg/m2) and central obesity (WHR > 1.0), with chronic cough (daily coughing with cough duration ? 3months) was determined using logistic regression adjusted for age, sex, smoking, pack-years, GORD, chronic rhinosinusitis, lung cancer, asthma, and COPD.

Results The present study included 5,007 participants (71.5 ± 7.5 years, 57.7% female), with a mean BMI of 27.6 ± 0.9 kg/m2, and a mean WHR of 0.98 ± 0.07 in men and 0.86 ± 0.07 in women. The prevalence of chronic cough, central obesity, and general obesity was 12.1% (n = 607), 17.0% (n = 853), and 24.2% (n = 1,213), respectively. BMI did not differ by chronic cough status (mean difference 0.178, 95% CI -0.255 ? 0.442; p=0.300) but WHR was higher in participants with chronic cough than in those without chronic cough, both in men (mean difference 0.019, 95% CI 0.009 ? 0.029; p <0.001) and in women (mean difference 0.011, 95% CI 0.003 ? 0.019; p=0.005). Similarly, central obesity (ORadj. 1.47, 95% CI 1.14 ? 1.89), but not general obesity (ORadj. 1.10, 95% CI 0.89 ? 1.35), was associated with chronic cough.

Conclusion Measures of body fat distribution show an association with chronic cough that is not identified by using BMI as an overall measure of adiposity.