Background: Different studies showed an association between biomass fuel exposure and chronic respiratory symptoms than spirometric abnormalities in exposed women. Objective: To assess the use of biomass fuel by women in rural areas at Damanhur, Egypt, as a contributing factor to chronic obstructive pulmonary disease (COPD) development. Methodology: The present cross-sectional study was conducted on 80 females regularly use biomass fuel for years attended the Damanhour chest hospital during the period from November 2019 to August 2020. All of them were subjected to history taking including duration of biomass fuel exposure, respiratory symptoms, comorbidities, then spirometry was performed. Results: A total of 49 (61.2%) females have COPD and 31 (38.8%) females had no COPD. Moreover, 56 (70%) females had small airway affection and 24 (30%) females had no small airway affection. Females having COPD had significantly longer duration of biomass exposure with a higher prevalence of Diabetes Mellitus (DM) than those with no COPD. The most significant predictive factors for COPD descending order were: dyspnea (ꞵ = - 3.9, p <0.001), cough, (ꞵ= - 2.55, p <0.001), and DM (ꞵ = - 2.3, p <0.003) and duration of biomass exposure (ꞵ = -  0.94, p <0.001). Conclusion:  COPD was prevalent among women who use biomass fuel and it was linked to the presence of respiratory symptoms, DM, and a longer duration of biomass exposure.