BACKGROUND AND OBJECTIVES: Tobacco smoking has been established as a major risk factor for chronic obstructive pulmonary disease (COPD) in women of developing countries, but emerging evidence suggests that biomass fuel is an important risk factor as well. The primary objective of the study was to find the true prevalence of COPD in Indian women exposed to biomass fuel using spirometry. We also aimed to find the determinants of underdiagnosis of COPD in these participants. METHODS: Women with a history of exposure to biomass fuel for >10 years were screened for COPD using spirometry following all standard protocols as per GOLD/ATS/ERS definitions. RESULTS: Of the 2868 women screened, a total of 529 (18.4%) women were confirmed to have COPD in which 123 (4.2%) were "Women with known COPD" and 406 (14.2%) "Women with new COPD". The mean age at the time of Diagnosis was 61±5.2 and 47±3.6 respectively. The duration of exposure to biomass fuel had a great impact on the risk of COPD with OR 1.2, 95% CI (1.1-1.9) for patients with 10-15 years exposure and OR 2.9, 95% CI (2.5-3.1) for exposure >25 years, p<0.001. CONCLUSION: The prevalence of COPD among women exposed to biomass fuel is very high. A strong correlation was found between the risk of COPD and the duration of exposure along with the age at which the exposure to biomass fuel begins. Underdiagnosis of COPD was frequent in women due to the lack of the availability of spirometry, lack knowledge of hazards of biomass fuel, a low level of education and the ignorance of the health care provider being the important determinants of underdiagnosis.