Crown Princess Mette-Marit of Norway was pictured using visible breathing assistance during a public engagement at the Constitution Day children's parade on Sunday.
The 52-year-old future queen was seen wearing a nasal cannula connected to an oxygen tank as she observed the festivities alongside her husband, Crown Prince Haakon, also 52, and their son Prince Sverre Magnus, 20.
The royals gathered at their residence, Skaugum in Oslo, to watch the traditional parade.
The Crown Princess has been managing pulmonary fibrosis since revealing her diagnosis eight years ago, a condition causing progressive lung scarring that makes breathing increasingly difficult.
Crown Princess Mette-Marit of Norway was pictured using visible breathing assistance during a public engagement at the Constitution Day children's parade on Sunday.
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When she first disclosed her health battle in 2018, the mother-of-three explained that she had been experiencing regular health challenges for several years before receiving clarity on the underlying cause.
"The condition means that my working capacity will vary," she stated at the time, adding that she and Crown Prince Haakon were going public partly because "in future there will be a need to plan periods of time without an official programme to accommodate treatment and when the disease is more active."
The announcement signalled that her royal duties would need to be scaled back periodically to manage the illness and its treatment requirements.
Professor Kristian Bjøro, the Crown Princess's physician at the National Hospital, has indicated that medical professionals have been tracking her condition over an extended period, noting that "disease progression has been slow over this period."
The royals gathered at their residence, Skaugum in Oslo, to watch the traditional parade.
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The particular form of fibrosis affecting Mette-Marit's lungs remains relatively uncommon, with the Royal House stating there is "broad consensus that, unlike other more common types of pulmonary fibrosis, it is not related to environmental or lifestyle factors."
Early detection has improved the prognosis for the 52-year-old, according to previous Palace communications, giving her a more favourable outlook than might otherwise have been expected.
Pulmonary fibrosis cannot be cured and deteriorates progressively over time, according to NHS guidance, which lists symptoms including persistent dry cough, breathlessness, fatigue, reduced appetite, weight loss, and clubbed fingertips.
Despite the limitations imposed by her diagnosis, the Crown Princess has expressed determination to maintain her public role wherever possible.
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Despite the limitations imposed by her diagnosis, the Crown Princess has expressed determination to maintain her public role wherever possible.
"Even if such a diagnosis will limit my life at times, I am glad that the disease has been discovered so early," she said when announcing her condition.
She added: "My goal is still to work and participate in the official programme as much as possible."
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