Yes, ducts can look terribly dusty. However, that dust will not become aerosolized during the normal operation of your furnace. There is an easy way to test this. Rent a particle counter and test the air flowing out of your registers before and after cleaning. You will not see any improvement in the air quality or any reduction in the airborne dust level. Think of it this way. Duct cleaning companies tell you that you need to clean your ducts when you can see a layer of dust in your ducts. Yet that very layer of dust is proof that duct cleaning is unnecessary, because that dust proves that the air movement in your furnace is not fast enough to re-aerosolize the dust.

In modern buildings, the design, installation, and control systems of these functions are integrated into one or more HVAC systems. For very small buildings, contractors normally estimate the capacity and type of system needed and then design the system, selecting the appropriate refrigerant and various components needed. For larger buildings, building service designers, mechanical engineers, or building services engineers analyze, design, and specify the HVAC systems. Specialty mechanical contractors then fabricate and commission the systems. Building permits and code-compliance inspections of the installations are normally required for all sizes of building.
PickHVAC Tips: First, see the PickHVAC tip above about sizing a central air conditioner. It applies to heat pumps just as much. Secondly, Even if the line set for the new heat pump is the correct size, we recommend replacing the set or at least the fittings. Old lines and fittings are a major source of leaks. When refrigerant leaks out, the heat pump efficiency suffers. Eventually, the unit stops providing heating and air conditioning, and it might break down.
The heat pump gained popularity in the 1950s in Japan and the United States.[13] Heat pumps can extract heat from various sources, such as environmental air, exhaust air from a building, or from the ground. Heat pumps transfer heat from outside the structure into the air inside. Initially, heat pump HVAC systems were only used in moderate climates, but with improvements in low temperature operation and reduced loads due to more efficient homes, they are increasing in popularity in cooler climates.
The fact is if they are dirty why not clean them. As for the Dr’s comment about if it is not disrupted it is fine. As a pet owner sometimes un disrupted pet hair will sit in the corner of a room or under a counter un disrupted but I still clean it when I notice it. Just because you cant see it doesn’t mean you should leave it there to collect more and more. The people that don’t want there air ducts clean either simply cant afford it but would like it done. OR! the crowd that are to cheap.. You should Clean all portions of your house.

The performance of vapor compression refrigeration cycles[26] is limited by thermodynamics. These air conditioning and heat pump devices move heat rather than convert it from one form to another, so thermal efficiencies do not appropriately describe the performance of these devices. The Coefficient-of-Performance (COP) measures performance, but this dimensionless measure has not been adopted. Instead, the Energy Efficiency Ratio (EER) has traditionally been used to characterize the performance of many HVAC systems. EER is the Energy Efficiency Ratio based on a 35 °C (95 °F) outdoor temperature. To more accurately describe the performance of air conditioning equipment over a typical cooling season a modified version of the EER, the Seasonal Energy Efficiency Ratio (SEER), or in Europe the ESEER, is used. SEER ratings are based on seasonal temperature averages instead of a constant 35 °C (95 °F) outdoor temperature. The current industry minimum SEER rating is 14 SEER.[27][dead link]
What you might not know is that the brand you choose is one of the most important factors in determining a fair HVAC installation cost. So, before delving in-depth, let’s take a quick look at the average prices of a new air conditioner and matching coil by brand…keep in mind, these are the average prices (by brand) that contractors pay for your AC equipment, and it is meant to give you a rough guideline until you are closer to buying:

Air duct cleaning service providers may tell you that they need to apply chemical biocide to the inside of your ducts as a means to kill bacteria (germs) and fungi (mold) and prevent future biological growth. They may also propose the application of a "sealant" to prevent dust and dirt particles from being released into the air or to seal air leaks. You should fully understand the pros and cons of permitting application of chemical biocides or sealants. While the targeted use of chemical biocides and sealants may be appropriate under specific circumstances, research has not demonstrated their effectiveness in duct cleaning or their potential adverse health effects. No chemical biocides are currently registered by EPA for use in internally-insulated air duct systems (see Should chemical biocides be applied to the inside of air ducts?).