When these aren't properly maintained and sanitized, they can build up dust, pollen, and even mold. This means when the air conditioner or heater turns on, the spores are released into the air for you to inhale. While some are less harmful, people who have allergies or sensitivity to certain spores will react negatively. Plus, mold is dangerous for anyone to ingest and should be avoided by regular maintenance.
We moved to a house built in 1965 from a 1915 house with a dirt basement. Against what I anticipated, the 1965 house was much dustier. It was like felt on top of everything. I cleaned and cleaned and it did become less dusty over time. We then found out a cat lady with over 2 dozen cats lived in the house in the past. We then had to get our furnace replaced and I was able to look down some of the duct work, the dirt and debris was 3-5 inches deep. Additionally, the basement ducts were entirely plugged with debris including dirt, seeds, ants, toys, etc. I had already removed what I could from those. We had our ducts cleaned last year, and the dust in the house is greatly reduced. Also have lost the runny nose I got after moving here. There are duct cleaning con artists out there, but ours did a good job.
The amount of debris or mold present in your system could certainly ratchet up the overall price. The cost of mildew removal is around $0.07-0.08 per square foot, on top of your initial cost, according to Blue Book. Removing these elements involves added time, special equipment and even special chemicals. In fact, you may be referred to a specialist if mildew and mold is too severe.
If the system is sealed air-tight and a really good filtering system is in place then you should NEVER have to clean your ductwork. Most dust people see in their homes (on beds furniture etc....) is broken down insulation that is being blown into the home from the attic (venturi effect) where the duct bucket (box etc...) is not sealed at the sheetrock ceiling. On the return side, ANY leaks in the ductwork will pull hot attic air and dust into the system, clogging up everything.
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?).