Background: Alveolar proteinosis is mainly autoimmune disease in which lipoproteins accumulate inside alveoli. In severe cases it presents with dyspnea, tachypnea and cough. Lung lavage is the treatment of choice in symptomatic cases. Objective: The aim of this study was to illustrate two different techniques of management of pulmonary alveolar proteinosis (PAP) whether unilateral or bilateral whole lung lavage (WLL), analysis of indications, superiority and the efficacy of the two techniques. Patients and Methods: This is a retrospective analytical study that included 31 patients; all were done in Kasr Alainy Teaching Hospitals in the period between 2012 and 2021. All of our patients had progressive severe respiratory symptoms. Pre-procedural, intra-procedural, and post-procedural data were recorded as well as postoperative mortality, complications, ICU stay, relapses, and the need for recurrent settings of WLL. Results: The median time from diagnosis of PAP to treatment was 10.6 months (range from 1 to 40 months). The median age was 39.7 years (ranging from 19 to 70 years). Male patients were 22 (71%), while female patients were 9 (29%). Unilateral WLL was utilized in 21 patients (67.7%) and bilateral WLL in 10 patients (32.3%). Marked improvement occurred in 13 patients (41.9%), 12 patients showed partial improved (38.7%), 3 patients were stationary (9.7%), and unfortunately, 3 patients (9.7%) worsened post lavage. Single relapse occurred in 9 patients, while multiple relapses occurred in 5 patients.  Conclusion: Bilateral WLL was found to be a good alternative to unilateral WLL, which is cost-effective, less time consuming and even may decrease the incidence of relapses (single or multiple) with no significant difference in the incidence of complications.