There are fears for Simon Cowell's health after he was spotted with a breathing exerciser while heading home from a dinner date with partner Lauren Silverman.
The music mogul had the medical equipment next to him, alongside a packet of cigarettes, while climbing into a car in London.
The breathing apparatus is often prescribed by hospitals to patients who need lung expansion therapy and is designed to help users take deeper breaths and open up the alveoli (air sacs) in the lungs.
Cowell, 61, broke his back after falling from an electric motorbike last August. However, sources say the breathing exerciser is not because of his accident.
"Simon has been using this type of breathing equipment for some time. It's not been prescribed as part of the rehab from his bike fall," a source told MailOnline.
"He appreciates the benefits and, being a heavy smoker for a number of years, it improves his air flow. He's got no qualms about it whatsoever."
Despite this, the photo has sparked public concern for his health.
"Actually, he doesn't look well, he looks quite ill to me. In all seriousness, I hope he's okay," one person commented.
Another wrote: "To be perfectly honest, when I look at him, he looks more like someone who has been fighting a serious illness."
A third added: "What's happened to him? I think he looks really ill."
The Lung Health Institute says "a breath exerciser is a respiratory device used to help patients improve their lung function".
"Breath exercisers work with a primary focus to improve airflow, achieve optimum lung capacity and strengthen the cough effort, which allows the clearing of airways.
"These small and compact devices are best used as supplementary additions to disease management and can often fit in even the smallest of bags and pouches.
In 2012, sources revealed Cowell carries bottled oxygen in a bid to remain youthful.
"Simon knows he's not getting any younger and is trying every trick to tackle it. He says it helps him relax and keep the stress at bay," the insider said.