Increasing demand on heating, ventilation, and air-conditioning (HVAC) systems and their importance, as the respiratory system of buildings, in developing and spreading various microbial contaminations and diseases with their huge global energy consumption share have forced researchers, industries, and policymakers to focus on improving the sustainability of HVAC systems. Understanding and considering various parameters related to the sustainability of new and existing HVAC systems as the respiratory system of buildings are vital to providing healthy, energy-efficient, and economical options for various building types. However, the greatest opportunities for improving the sustainability of HVAC systems exist at the design stage of new facilities and the retrofitting of existing equipment. Considering the high available percentage of existing HVAC systems globally reveals the importance of their retrofitting. The attempt has been made to gather all important parameters that affect decision-making to select the optimum HVAC system development considerations among the various opportunities that are available for sustainability improvement.