Background: Despite the severe burden of tuberculosis (TB) on national economy in Bangladesh very little information is known about the relationship between biomass fuel smoke exposure and pulmonary TB. Hence a case-control study was conducted among female in rural areas of Bangladesh. Purpose: To determine whether biomass fuel smoke as an exposure increases the risk for pulmonary TB among female of Ullahpara and Shahzadpur Upazilla (Subdistrict) north western region of Bangladesh. Methods: Physician-diagnosed cases of sputum positive pulmonary TB(n=114) and healthy controls(n=147) a total of 261 were enrolled from different DOTS centers in those two specific sub-districts of Sirajgong districts. Interviews were conducted in the DOTS centers using a pretested questionnaire to collect information on type of cooking fuel, education, occupation, socio-economic status, type of kitchen, ventilation of kitchen etc. The conditional logistic regression model was used for control of confounding. Results: The study population was predominantly in the 20-40 year-old age group (49.1%) and lived in rural areas (90.4%). Majorities were illiterate (47.3%) and housewives (69.2%) and almost 98.2% had a monthly family income of no more than 20,000 Tk. Among the cases 50.9%, 46.5%, and 2.6% used tree, cowdung (biomass fuel) and liquid or supply (L/S) gas respectively, whereas among controls the respective figures were 55.8%, 38.8% and 5.4%. The unadjusted Odds Ratio (OR) for biomass fuel compared with L/S gas was 2.480 (p=0.197). Adjustment for confounding factors (education, type of kitchen, type of oven, in touch of TB patients, and smokers in the family) and interaction between cooking fuel and smoker in family revealed an OR of 7.319(p=0.009) for biomass fuel in compared with L/S gas. Conclusion: Cooking with biomass fuel increases the risk of pulmonary TB.