A thorough visual inspection is the best way to verify the cleanliness of your heating and cooling system. Some service providers use remote photography to document conditions inside ducts. All portions of the system should be visibly clean; you should not be able to detect any debris with the naked eye. Show the Post-Cleaning Consumer Checklist to the service provider before the work begins. After completing the job, ask the service provider to show you each component of your system to verify that the job was performed satisfactorily.
There is a lot of good, general information in the article. As with anything, the homeowner should do their due diligence in getting enough information to make an educated decision. Should duct-work be cleaned? YES! Does it need to be cleaned annually or even every second or third year? Not necessarily. It all depends on a bunch of variables. You're right that a well designed and balanced system will deliver the right amount of air flow, but sometimes conditions outside the home/business, make it a necessity to get the ducts cleaned. As for mold? NO filter is going to address a mold issue. If you have mold, you have a moisture issue that needs to be addressed. Also, in my 38 years of experience in the HVAC and sheet metal industries, washable filters are one of the reasons ducts need to be cleaned. They are no where near efficient in cleaning/filtering the air to the level that they should.

In most modern homes with up-to-date heating and air conditioning systems, filters are changed regularly through the year, so you may not even need to hire a professional. However, keep your eyes open for the accumulation of dust, dirt, dander and mold. If you see it despite regularly changing your filters it could be an indication you need a high-pressure cleaning.
I hope that those customers you have with breathing problems don't follow your advice too closely. You are doing them a disservice. Dirt in your ducts does not always stay there, depending on what the contaminants are. I bet you tell your customers not to worry about mold either- just to kill it with bleach. Educate yourself before opening your mouth- You may kill someone someday with your opinion.
Having the most energy-efficient system ever built won't matter much if it's not maintained. Lack of maintenance is the number one killer of HVAC systems. Before each cooling season, it's recommended that your system get a professional tune-up. However, there are things you can do in the meantime to make sure your system runs efficiently throughout the year.
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